Oct. 28, 2024
Starting Jan. 1, 2025, members of Blue Advantage PPOSM and Blue Preferred PPOSM individual market benefit plans with Blue Cross and Blue Shield of Oklahoma who purchased their plans on or off the marketplace exchange will no longer have access to non-urgent and non-emergency out-of-state care beyond the border counties in Kansas, Colorado, New Mexico, Texas, Arkansas and Missouri that border Oklahoma. This change does not apply to members with group coverage.
Coverage for non-urgent and non-emergent out-of-service area care will only be available if the service is not available in the service area of the member’s Blue Advantage PPOSM and Blue Preferred PPOSM plan. (Check our provider directory for in-area care options.) Beginning Jan. 1, if non-urgent or non-emergency care is not available in the service area of the plan, a member may request approval of a waiver for out-of-state coverage beyond border counties by calling the customer service number on their ID card. Members must have requested and received an approved waiver in advance of receiving care for their benefits to apply.
Remember: Non-urgent or non-emergency care outside of Oklahoma and beyond border counties will not generally be covered under these plans and will ONLY BE COVERED if a member requests and receives an approved waiver in advance of receiving care. A waiver will be denied if the service is available in-state or in border counties. Members will be redirected to available, local in-network services.
What’s not changing: Members who receive services from providers in Oklahoma or from in-network (BlueCard® contracted) providers within the bordering counties do not require a waiver. In addition, nothing is changing for urgent and emergency services.
Requesting a waiver: Members or providers can request a waiver for non-urgent or non-emergency care outside Oklahoma and the counties in Kansas, Colorado, New Mexico, Texas, Arkansas and Missouri, that border Oklahoma when such care is not available in Oklahoma or from an in-network provider in its border counties. The member is responsible for securing the waiver, but a provider may request it on their behalf.
Out of state providers should call Customer Service at BCBSOK at 866-520-2507 to request a waiver. In state or out of network providers should request a waiver by submitting a Referral request in Availity® Essentials, which is accessible in the main navigation menu under Patient Registration.
Members with approved waivers: If members are approved to receive non-urgent or non-emergency out-of-state health care services beyond the counties bordering Oklahoma, those services will be reimbursed at the in-network benefit level.
Members without approved waivers: If members receive non-urgent or non-emergency care outside Oklahoma and its bordering counties without an approved waiver, their services will not be covered under their benefit plan. The member will be responsible for the full cost.
More information: Check members’ eligibility and benefits through Availity Essentials or your preferred vendor portal prior to rendering services or recommending care.
To find in-network care, check our provider directory.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.