Last Updated: January 1, 2024 at 10:34 pm
At BCBSAZ Health Choice Pathway (HMO D-SNP), members are our number one priority. Our mission is to treat you with the utmost respect and dignity while providing you safe, effective, quality healthcare.
One way to accomplish this is to provide members with outstanding customer service. Whether you need member support or you simply have some questions that need answers, we’re always here to answer every question and address every concern.
We are here to help. If you have questions, please call Member Services at 1-800-656-8991, TTY 711, 8 a.m. to 8 p.m., 7 days a week.
A few examples the BCBSAZ Health Choice Pathway Member Services team can assist with:
- Check eligibility and/or benefits
- Determine benefits and financial responsibility for a specific service or treatment from a specified provider or institution.
- Request a replacement ID Card
- Member demographic updates (such as change of address or phone number/contact information)
- Assistance with locating a provider
- Pharmacy benefit information
- Determine financial responsibility for a drug, based on the pharmacy benefit
- Check the status on denials or appeals (Or, initiate the exceptions process for Medicare)
- Order a refill for an existing, unexpired mail-order prescription
- Find the location of an in-network pharmacy in close proximity based on zip code search
- Determine the availability of generic substitutes
- Change a primary care provider, as applicable
- Prior Authorization information (Medical Services)
- Determine how and when to obtain referrals and authorizations for specific services, as applicable.
- Check the status on denials or appeals
- Check Claims Status (non-payment of a claim)
Our Member Services Department is open 8 a.m. – 8 p.m., 7 days a week and can be reached by calling 1-800-656-8991. TTY users should call 711.
Or, you may e-mail Member Services at HCHComments@azblue.com.
For additional information related to your Pharmacy benefit, or prescription drugs, you may also visit the Prescription Drug Information page
Referrals and Prior Authorizations
Referrals
A referral is a written order from your primary care provider (PCP). In some situations, our plan or your PCP must give you a referral for you to get certain medical services from another provider in our plan.
You can get the services listed below without getting a referral from your PCP.
- Emergency care or urgently needed services
- Flu shots, COVID-19 vaccinations, Hepatitis B vaccinations, and pneumonia vaccinations
- Routine women’s health care includes breast exams, screening mammograms (x-rays of the breast), Pap tests, and pelvic exams as long as you get them from an in-network provider.
- In-network Specialist provider office visits do not require a referral, except for pain management services.
You can also get other kinds of care without a referral from your PCP (see Section 2.2 of Chapter 3 in your Evidence of Coverage).
Prior Authorizations
Some medical tests or services require prior authorization before they are scheduled. Your provider requests prior authorization on your behalf. A prior authorization, commonly called a ‘PA’, is not a promise BCBSAZ Health Choice Pathway will cover the cost of the service.
A PA request is a form your provider fills out and sends to BCBSAZ Health Choice Pathway. Our prior authorization department will review the request and make a decision. A decision for a standard request is made within 14 calendar days and a decision for an expedited request is made within 3 calendar days. You and your provider will be notified if the service is approved or denied.
If you have a question about referrals and prior authorizations, Member Services can help you. Call us at 1-800-656-8991 (TTY 711). Our Member Services department is open 8 a.m. to 8 p.m., 7 days a week. You can also contact us by e-mail at HCHComments@azblue.com.
Your Health Care Buddy
BCBSAZ Health Choice Pathway understands the importance of individualized care. That is why we assign every member their very own health care buddy.
Your Health Care Buddy can help with many things, like:
- Answer questions about your benefits
- Help you find a doctor
- Set up your health care appointments
- Help you get your prescription drugs
- Help you get prior authorization for medical services
- And much more!
Your buddy is just a phone call away!
