There is no specific claim form for ASO non-network vision, however, the below standard information must be submitted by either the member or provider. When the provider submits the claim information, the member will be notified via Explanation of Benefits (EOB) once Guardian has processed it. The claim needs to include the following information along […]
If you visit a network provider, your provider should submit your claim to the appropriate Blue Cross Blue Shield office. Your claim will then be sent to the Health Plan for processing. If you visit a non-network provider, your provider should submit your claim to the appropriate Blue Cross Blue Shield office. In some cases, […]
You must request reconsideration of a fully or partially denied claim within 180 days of the denial of the claim. The request must be in writing, submitted to the Plan Office and accompanied by a statement giving the reasons the denial is believed to be incorrect.
Pre-authorizations are required for eyelid, breast and nasal surgeries because these procedures often fall under the cosmetic exclusion. Pre-authorizations are also required for all transplant surgeries, many non-elective surgeries, and many other services. It is always best to contact the Plan Office at least two weeks prior to your proposed surgery.
No. Although the Plan will cover durable medical equipment (DME) when prescribed by a doctor, general use items such as an exercise bike are not covered.
No. There is no Plan benefit for weight loss programs,whether or not they are pursued under medical or physician supervision, unless specifically listed as covered in this plan. This exclusion includes, but is not limited to, commercial weight loss programs (Weight Watchers, Jenny Craig, LA Weight Loss) and fasting programs. This exclusion does not apply […]
The Plan will cover nutritional counseling for certain chronic illnesses.
No. Any surgery performed to correct a refractive error, such as LASIK, is not covered under the Plan
Yes. Claims incurred in foreign countries are covered provided that they are as a result of a life threatening injury. The provider may or may not file the claim for you. If you have to pay for services upfront, submit itemized bills to the Trust Fund Office.
Occupational injuries or illnesses are normally covered under Workers’ Compensation Insurance. On-the-job injuries or illnesses are not covered by the Health Plan.