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Rim of the World Unified School District
The following references below are a guide to help you find answers to questions you may have with your Blue Shield of California health plan. In addition to the following resources, if you are experiencing difficulties with the plan or being billed by a provider, please contact:
Pam Stinson
Assistant Customer Service Representative
Toll Free: (877) 924-4494 Ext. 1
Fax: (909) 798-9811
Email: pam.hoffman@hubinternational.com
Blue Shield Member Services:
1(800)642-6155 (Service Hours: Monday – Friday, 7:00 a.m. – 7:00 p.m.) Or visit www.blueshieldca.com
Frequently Asked Questions
How do I contact Blue Shield?
When should I contact Blue Shield?
What happens if I receive a bill or claim for services by mistake?
How do I locate a Blue Shield HMO or PPO Provider?
How long should I expect to wait for an appointment with a physician?
I am not feeling well, it is after hours, and I don’t know if it is serious enough to go to an urgent care center or emergency room – is there someone I can call and get advice?
What Urgent Care Center should I go to?
How do I add a new spouse or dependent(s)?
How can I get a second opinion or what do I do if I am being denied a second opinion?
What are my co-payments at Urgent Care Centers?
How do I locate information about Prescription Drugs?
Is Prescription Mail Order Service available?
How do I file an appeal or grievance with Blue Shield?
How do I access Mental Health Services with Blue Shield?
What wellness programs are available to me?
A spouse, dependent, or I have been diagnosed with a serious illness or I have questions or concerns about a treatment of an illness, whom can I call?
How do I contact Blue Shield?
You can contact Blue Shield by calling Member Services at 800-642-6155
(Service Hours: Monday – Friday, 7:00 a.m. – 7:00 p.m. or by going on their website at www.blueshieldca.com. Website inquires will be answered within 48 hours.
When should I contact Blue Shield?
You should contact Blue Shield to verify eligibility, check on a claim or benefit status, update your mailing address, order ID cards, change your primary care physician, and file appeals or grievances.
What happens if I receive a bill or claim for services by mistake?
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Call Blue Shield Member Services as soon as possible, so they can appropriately process or route the claim.
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If you continue to have difficulties, please contact the High Desert & Inland Trust (HDIT) at 877-924-4494 ext. 1. (Service Hours: Monday – Friday, 8:00 a.m. – 5:00 p.m.).
How do I locate a Blue Shield HMO or PPO Provider?
An HMO or PPO Provider can be located on Blue Shield’s website – www.blueshieldca.com and clicking on “find a provider now” or by calling Blue Shield Member Services.
How long should I expect to wait for an appointment with a physician?
If you do not receive an appointment within the accessibility standard shown in the table below, you should call Blue Shield Member Services at 800-642-6155.
Type of Appointment |
Accessibility Standard |
Access to preventive care with PCP, Nurse Practitioner, or Physician Assistant |
Within 30 calendar days |
Access to routine, non-urgent symptomatic care appointment with member’s assigned PCP |
Within 7 calendar days |
Access to routine, non-urgent symptomatic care appointment with specialists |
Within 14 calendar days |
Access to urgent care appointment with your PCP, a specialist, a covering physician, or an urgent care provider |
Within 24 hours |
Emergency Care |
Immediate |
I am not feeling well, it is after hours, and I don’t know if it is serious enough to go to an urgent care center or emergency room – is there someone I can call and get advice?
Yes! Blue Shield has a nurse-line available to ask health related questions regarding you or a family member. Call (866) 543-3728 – it is available 24 hours a day, 7 days a week. Have your insurance card available when you call.
What Urgent Care Center should I go to?
HMO: You are required to use your IPA/Medical Groups contracted Urgent Care Centers. Contact your Primary Care Physician (PCP) or IPA/Medical Group prior to seeking urgent care for instructions.
PPO: You may use any urgent care facility that accepts Blue Shield of California PPO plans.
How do I add a new spouse or dependent(s)?
Contact your district no later than 31 days from the date of the event to enroll a newborn, legally adopted child, or newly married spouse or domestic partner. Dependents not added within this period, may not be eligible until the next open enrollment period.
How can I get a second opinion or what do I do if I am being denied a second opinion?
Call Blue Shield member services at (800) 642-6155. A member services representative will assist you on how to obtain a second opinion.
What are my co-payments at Urgent Care Centers?
HMO: If within your contracted IPA/Medical Group: office visit copay. For out-of-service area: $25. If you go to an urgent care that is within your service area, but not contracted with your IPA/Medical Group, you will be financially responsible for the services.
PPO: For a preferred urgent care center: office visit copay. For non-preferred urgent care center: deductible, plus the out-of-network percentage for your plan.
How do I locate information about Prescription Drugs?
Go to Blue Shield’s website at www.blueshieldca.com and click on “pharmacy” on the far left side of the web page. There you can locate information about drugs, drug coverage or formulary status, costs and generic alternatives, drug interactions, find a pharmacy in your area, or submit confidential questions to a pharmacist.
Is Prescription Mail Order Service available?
Effective January 1, 2008 Blue Shield moved to PrimeMail as their mail order prescription provider. Anyone who had an open prescription with refills remaining with Express Scripts was automatically transferred over to PrimeMail. The FDA prohibits the transfer of prescriptions for controlled substances. These medications will have to be re-ordered.
To enroll in prescription mail order service go to www.MyPrimeMail.com and click on “Order a new prescription” to print order forms. In addition, if you register for online access you will be able to check order status, order refills, and review your account. However, if you prefer, PrimeMail representatives may be reached at (866) 346-7200 to assist you with these same services.
How do I file an appeal or grievance with Blue Shield?
You can initiate a grievance in any of the following ways:
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Call member services at Blue Shield at (800) 642-6155 and verbalize your grievance.
- Submit a letter to Blue Shield at Member Services Appeals and Grievance
P.O. Box 558
El Dorado Hills, CA 95762-0011
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Complete a “Grievance Form” online at www.blueshieldca.com and follow the directions provided.
How do I access Mental Health Services with Blue Shield?
HMO Members: For non-emergency mental health and substance abuse services contact United States Behavioral Health (USBH) at 877-263-8827. Your primary care physician may also contact USBH for information regarding participating providers. All non-emergency mental health and substance abuse services must have prior authorization by USBH staff. Please call USBH prior to making any appointments with a provider.
PPO Members: For mental health and substance abuse services contact United States Behavioral Health (USBH) at 877-263-8827. These services require USBH prior authorization. Please call USBH prior to making any appointments with a provider.
What wellness programs are available to me?
You have two programs available through the Trust: Healthy Lifestyle Rewards and Healthyroads.
Healthyroads:
As a district employee covered by HDIT’s Blue Shield medical plan, you may participate in Healthyroads – at no cost to you! Healthyroads utilizes both telephone and/or online programs to help individuals achieve new levels of health and vitality.
Call 877-330-2746 or visit the website at www.healthyroads.com for further information, or to begin planning your health improvement strategy!
A spouse, dependent, or I have been diagnosed with a serious illness or I have questions or concerns about a treatment of an illness, whom can I call?
Best Doctors:
This program gives you the opportunity to receive answers from world-renowned doctors without ever leaving your home! These expert doctors will review your medical records to confirm your diagnosis and medical treatment. They can also identify an incorrect diagnosis, or recommend a safer or more effective course of treatment. Best Doctors will provide you and your doctor with an easy-to-understand report that can help make sure you are receiving the best care possible.
You can take advantage of this unique service by calling 866-904-0910. You can also learn more about the Best Doctor’s program by visiting their website at www.bestdoctors.com/members.
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