From recent Blue Shield mailer (download .pdf here):

Learn how to get acupuncture or chiropractic services, hearing aids, 100-day prescription supplies, and submit appeals.

Blue Shield of California is an independent member of the Blue Shield Association.

NEW 100-DAY OUTPATIENT PRESCRIPTION MAINTENANCE DRUG SUPPLY

  • You may obtain up to a 100-day supply of maintenance medication from any network pharmacy, including Amazon Pharmacy for the same co-pay as a 90-day supply.
  • If you want to get your 90- or 100-days maintenance prescription (non-Specialty Drug) for the price of two months, you must fill your prescription at a Blue Shield in-network pharmacy with preferred cost sharing. Go to: https://myoptions.blueshieldca.com/sfhss_retiree.
  • Then, select Pharmacy Locator tool on the right-hand side as you scroll down to the middle of the page.
  • Your provider must write the prescription for a 100-day supply. Generally, pharmacies would not be able to increase the day supply without a prescription from your provider, which specifies the number of days for the medication.
  • If your current maintenance medication prescription is written for less than a 100-day supply, you will need to ask your provider to write you a new prescription for the extended-day supply.
  • Please note that you are not required to obtain an extended-day supply. This is just an additional available benefit, for your convenience and cost savings.
  • •You can have your maintenance medications sent directly to your home through Amazon Pharmacy. Your dedicated Amazon Pharmacy Customer Service contact is available by calling (856) 208-4665, to help you with any questions you may have. To use Amazon Pharmacy, you do need computer access to set up an account and use this benefit.

APPEALS NAVIGATION (RECONSIDERATION)

  • Members have a right to file an appeal if they want Blue Shield to “reconsider” and/or change a decision that was made. Appeals can be made for things such as services and/or drugs covered, or how much Blue Shield will pay for a service and/or drug.
  • For reconsideration of a decision for Medical or Part D prescription drug services you have not received: You must file the appeal request within 65 calendar days from the date on the original written determination notice that Blue Shield sent you.

For your Medical Benefits:

  • For reconsideration of a decision about payment for services you already received: After Blue Shield receives your appeal, they have 60 calendar days to reconsider their decision. If they find in your favor, they must issue payment within 60 calendar days of the date of receipt of your appeal request.
  • Standard turn-around time of an appeal: After Blue Shield receives your appeal, they have up to 30 calendar days to make a decision. If your health condition requires it, they will make a decision sooner. Refer to the Evidence of Coverage (EOC) for more information.

For your Prescription Drug Benefits:

  • For a decision about payment for Part D prescription drugs you already received: After Blue Shield receives your appeal, they have 14 calendar days to make a decision. If they find in your favor, they have 30 days from the date of receipt of your appeal request to issue payment.
  • Standard turn-around time of an appeal: After Blue Shield receives your appeal, they have up to seven (7) calendar days to make a decision but will make it sooner if your health condition requires it.

HOW TO SUBMIT AN APPEAL

  1. You can obtain the Appeals Form online:
    www.blueshieldca.com/en/medicare/member-resources/appeals-and-grievances
  2. You can then submit the completed form two (2) ways:
    1. Mail:
      Blue Shield of California
      ATTN: Medicare AGD
      PO Box 927
      Woodland Hills, CA 91365
    2. Fax: (916) 350-6510

REQUESTING A FAST MEDICAL OR PRESCRIPTION APPEAL:

  • If you or your doctor believes that waiting for a standard appeal decision could seriously harm your health or ability to function, you may ask for an expedited fast appeal.
  • To ask for an expedited fast appeal, you, your doctor, other prescriber, or authorized representative must call, fax, or write Blue Shield at the numbers or address listed above.
  • If you are given an expedited fast appeal, Blue Shield will give you their decision within 72 hours after receivingthe request. Blue Shield will give you the decision sooner if your health condition requires it. Refer to the Evidence of Coverage (EOC) for more information.

HEARING AID REIMBURSEMENT

  • You can obtain hearing aids and associated services from a provider of your choice.
  • Blue Shield will reimburse for hearing aids up to $2,500 per ear, every three years.
  • Simply provide the following information for reimbursement:
    Member Name and Member Number, Proof of payment, Date of Service, and copy of Itemized Bill.

You can submit via:

  1. Email: membersvcs@blueshieldca.com
  2. Fax: (877) 251-6671
  3. Mail:
    Blue Shield of California
    PO Box 272640
    Chico, CA 95927

ADDITIONAL QUESTIONS & SUPPORT

  • If you have any questions or issues, Blue Shield’s dedicated SFHSS Concierge Member Services is available at (800) 370-8852 (TTY 711) from 8 a.m. to 8 p.m. PT, seven days a week, year-round (only closed on Thanksgiving Day and Christmas Day).
  • If you need assistance with any medical appointments, our Care Navigator team is available to assist with scheduling appointments, finding providers, managing authorization issues, and more. You can reach the Care Navigator team by contacting your dedicated SFHSS Concierge team and asking to connect with the Care Navigator team.