ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación llamada 1-800-200-4255 (TTY: 711 ).

Medical Policy Overview & Search. Medical policies are scientific documents that define the technologies, procedures, and treatments that are considered medically necessary, not medically necessary, and investigational link to investigational policy. Our medical policies help us determine what technology, procedure, treatment, supply, equipment, drug, or other service …

To use our paper forms, download the appropriate form by clicking the links below and follow the instructions on the form. Dental Claim Form [PDF]. A form for submitting a dental claim with instructions on filing a claim.

ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Call1-800-472-2689(TTY: 711).

Coverage Policy Documents. Under the Affordable Care Act (ACA), health insurers and group health plans are required to provide a Summary of Benefits and Coverage (SBC), along with a glossary of common health care terms, to consumers.In addition, Blue Cross Blue Shield of Massachusetts provides online access to the corresponding coverage policy to all of our fully …

Effective July 1, 2025, medical policy change for the Blue Cross Blue Shield of Massachusetts formulary. Effective July 1, 2025, we're updating a medical policy for our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex ®´1 plans with a three-tier pharmacy benefit.. Complete details about these changes will be available by February 28, …

3 Massachusetts Collaborative — Massachusetts Standard Form for Prescription Drug Prior Authorization Requests April 2024 (version 1.0)

Here’s what you get for around $290 a month: Pay $0 out-of-pocket for preventive care, routine physicals, OB/GYN, well child visits, routine hearing and vision exams, and family planning.There’s no copay or deductible. Pay no more than $35 per visit for your first three sick-care or non-preventive office visits. F or additional visits, you are responsible until the …

4 • Cryopreservation of embryos or eggs for reciprocal IVF (unless otherwise specified in the member’s subscriber certificate/rider). • Sperm storage/banking for males requesting this service for convenience or “back-up” for a fresh

General Member Service Correspondence. Blue Cross Blue Shield of Massachusetts P.O. Box 9134 N. Quincy, MA 02171-9134