FAQs & Upcoming Events
What is the frequency that a patient can get a cleaning and perio maintenance?
Every 6 months per procedure code. They do not share a limitation.
What are my Mental Health & Substance Abuse Benefits?
Individual & Family Counseling, Mental & Nervous Conditions, and Substance Abuse Benefits are administered by Mental Health Consultants (MHC). Plan year beginning May 1, 2017 all In-Network claims are covered at 90% with a 10% Coinsurance.
All Behavioral Health Claims should be sent to:
Mental Health Consultants, Inc., 1501 Lower State Road, Building D, Suite 200, North Wales. PA 19454
(800) 255-3081 or locally at (215) 343-8987
Covered Behavioral Health Benefits include:
- Psychiatrists & Psychologists
- Social Workers & Licensed Counselors
- Substance Abuse
- In-Patient & Out-Patient Treatment Facilities
- Individual & Family Counseling
- Mental & Nervous Conditions
Why did Blue Cross deny my claim for Durable Medical Equipment?
Durable Medical Equipment claims are not covered through Blue Cross. They are processed by the Fund Office. All claims should be sent to 1811 Spring Garden Street, Philadelphia, PA 19130. The provider can call the Fund Office to verify your eligibility.
The Fund uses Medicare pricing as its guidelines for covered services and payments. There is a $100.00 deductible per appliance. After that the Fund will pay 80% of the remaining balance up to $1,200.00.
Please note, supplies are not a covered benefit.
If you need a DME Product, please ask you provider to submit a copy of the script or a letter of medical necessity with the claim in order for the Fund to make payment.
Do I need a special form to take to my vision provider?
Yes, if you pay for any out-of-pocket vision expenses to a provider that does not participate with the Benefit Fund’s Vision Plan, you will need the Vision Benefit Direct Reimbursement Form. In order to be reimbursed, this form needs to be filled out and sent to the Fund Office, along with your original itemized paid receipt.
What is my cost for labwork or radiology?
Lab work is covered at 100% through Blue Cross when you visit LabCorp. Lab work done at any other In-Network location is covered but has a 10% coinsurance copay.
Radiology and other covered services processed through HealthCare Solutions will be covered at 100% provided you called HealthCare Solutions at 1-800-655-8125 for a claim number prior to your visit. Please click here to view a list of covered services through HealthCare Solutions.