Verifying Coverage for Services
Before receiving services, make sure it's covered
All members are encouraged to verify coverage for services before receiving them. Doing so will tell you:
- if the desired service/supply is covered under your health plan
- any requirements you must provide to receive the service/supply
- the cost you may pay for the service/supply
You should also be aware of any pre-existing conditions or waiting periods.
Non-group or Group Member?
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Non-group members should follow the steps below to verify coverage.
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Group members should call customer service, as group guidelines and/or special circumstances may apply.
Gather all the documents
Your contract consists of the following:
- Certificate of Coverage
- Outline of Coverage (member secure site
) - Additional contract documents (riders, endorsements)
- ID card
Go to the "Covered Services" section of your Certificate of Coverage
Determine if the desired service/supply is listed.
| If service/supply is... | Then.. |
| Listed | Skip to step #5 |
| NOT listed | Continue to step #3 |
Check the "General Exclusions" section of the your Certificate of Coverage
Determine the service you need is not listed
| If service/supply is... | Then.. |
| Listed | Service is not eligible for benefit |
| NOT listed | Continue to step #4 |
Review your additional contract documents (riders, endorsements)
Determine if the service/supply is listed as either a specific exclusion or additional benefit specific to your policy.
| If service/supply is... | And is.. | Then... |
| Not listed as a general exclusion | Not listed as an exclusion in any of your contract documents | Service/supply is generally eligible for benefits. |
| Not listed as a general exclusion | Listed as an exclusion in your additional contract documents | Service/supply is an exclusion and is NOT eligible for benefits |
| Listed as a general exclusion | Listed as an exclusion in your additional contract documents | Service/supply is an exclusion and is NOT eligible for benefits |
NOTE: If your claim for a service/supply denies, you have the right to appeal.
See if the service or supply needs prior approval. Find what you may pay, check your outline of coverage.
| If service/supply... | Then... |
| REQUIRES prior approval | Follow the instructions for obtaining prior approval. |
| Does NOT require prior approval | You have completed the verifying coverage process. |
NOTE: Not all services will list a price.
Need Help or Have Questions?
Call customer service, 1-800-247-2583
Did you know...
Non-group members are members who don't receive coverage through an employer, they purchase it directly from BCBSVT.
Group members are members who receive BCBSVT coverage through their employer.