![]() Medical condition, mental health, or substance use disorder condition which Our plans cover emergency care 24 hours a day, anywhere in the world. Members should call 911 or seek care immediately if they have a medical emergency condition. For full coverage provisions, including a description of waiting periods, limitations and exclusions, please contact Customer Service. This is not a complete explanation of covered services, exclusions, limitations, reductions or the terms under which the program may be continued in force. Note: Plan limitations and exclusions vary widely by contract, and are subject to change. Treatment for work-related conditions for which benefits are provided by Workers' Compensation or similar coverage.Services received when the member is not covered by the program.Services payable by other types of insurance coverage.Services in excess of specified benefit maximums.Services determined by us to be not medically necessary.Cosmetic or reconstructive services, except as specifically provided.Conditions arising from acts of war, or service in the military.(IVR is not available for service pertaining to the Federal Employee Program or BlueCard.)īenefit plans typically have exclusions and limitations-services and supplies that plans do not cover.īenefits are not provided for services, treatment, surgery, drugs or supplies for any of the following: If you make an error while keying in the member ID number, press the * key and the system will prompt you to re-enter it.Ĭontact IVR at 80, option 2.If you do not respond in another five seconds, you will be routed to a customer service representative (during normal Customer Service hours). If you do not respond to each prompt within five seconds, the system will repeat the prompt.If you request eligibility verification for more than one member at the same time, and you encounter subscriber or birth date errors, note them and wait until you have completed your inquiries before connecting to a customer service representative.Once familiar with the script, you no longer need to listen to the complete prompt before entering a selection.Enter the member's date of birth as month (two digits), day (two digits), and year (four digits). Key in or say the member's identification number.Information available on the IVR system varies by plan. Callers enter the member's ID number, date of birth, and the physician's or other provider's tax ID number to obtain eligibility, general benefit information, and claims information. Many Customer Service numbers offer an IVR option. Our Interactive Voice Response (IVR) provides self-service specific information and is available 24 hours a day, seven days a week.
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