2019 BlueCross Total (PPO)

Would you like a Medicare Preferred Provider Organization (PPO) plan with built-in prescription drug benefits? With BlueCross Total (PPO), you can enjoy all of the benefits original Medicare offers — and more.

BlueCross Total is open to residents in 23 South Carolina counties who have both Medicare Part A and Part B. Our service areas are:

  • BlueCross Total Upstate — Anderson, Cherokee, Greenville, Oconee, Pickens, Spartanburg and York counties.
  • BlueCross Total Midlands/Coastal — Aiken, Calhoun, Fairfield, Florence, Horry, Kershaw, Lexington, Orangeburg, Richland, Saluda and Sumter counties.
  • BlueCross Total Lowcountry — Beaufort, Berkeley, Charleston, Dorchester and Georgetown counties.

How Much Does BlueCross Total Cost?

The monthly premium for BlueCross Total is:

  • BlueCross Total Upstate — $19.00
  • BlueCross Total Midlands/Coastal — $25.00
  • BlueCross Total Lowcountry — $25.00.

You must continue to pay your Medicare Part B premium.

Can I Choose My Doctors?

BlueCross has formed a network of doctors, specialists and hospitals. BlueCross Total members may elect to receive care from in-network providers, or out-of-network providers who are eligible to participate in Medicare, as long as the services are covered benefits and are medically necessary. However, if you use an out-of-network provider, your share of the costs for your covered services may be higher. See our plan's Out-of-Network Coverage Rules for more information.You can find an up-to-date list of out-of-network providers who are eligible to participate in Medicare hereIMPORTANT: ensure you select the "National Medicare Advantage PPO" option when searching for providers.

As a member of BlueCross Total, you do not have to choose a network Primary Care Provider (PCP); however, we strongly encourage you to choose a PCP and let us know whom you have chosen. Your PCP can help you stay healthy, treat illnesses, and coordinate your care with other health care providers. You do not need a referral to visit a specialist.

You can find an up-to-date list of Primary Care Providers, Specialists, Durable Medical Equipment Suppliers and Hospitals in our network in our online Doctor and Hospital Finder. Or, you can view a complete list of providers in our printed Provider Directory. If you would like a printed Provider Directory mailed to you, please submit an online directory request, or call Customer Service at 1-855-204-2744.

Prescription Drug Coverage

BlueCross Total includes coverage for Medicare Part D prescription drugs. For an explanation of the rules you must follow when you get your Part D drugs, visit the plan's Prescription Drug Page. The page includes information about how to use the plan's List of Covered Drugs (Formulary). You also can review several kinds of restrictions that apply to coverage for certain rules. The page explains where to get your prescription drugs filled.

How Can I Compare My Options?

You can compare BlueCross Total to other plans using our Summary of Benefits. Please note the Summary of Benefits does not list every service that we cover, or list every limitation or exclusion. To get a complete list of our benefits, please review the Annual Notice of Changes: BlueCross Total Upstate ANOC, BlueCross Total Midlands/Coastal ANOC or BlueCross Total Lowcountry ANOC.  Also review the annual Evidence of Coverage for you plan: BlueCross Total UpstateBlueCross Total Midlands/Coastal or BlueCross Total Lowcountry.

Can I Change Plans After I Enroll?

Enrollment in this plan is generally for the entire year. You may leave this plan or make changes during the Annual Election Period from Oct. 15 to Dec. 7. The Medicare Advantage Open Enrollment Period (OEP) occurs each year between Jan. 1 – Mar. 31. If you are enrolled in a Medicare Advantage Plan you can leave your plan and switch to Original Medicare or join another Medicare Advantage plan.  Medicare may also allow you to change plans under special circumstances, such as:

  • If you permanently move out of your plan’s service area
  • If you get help from your state Medicaid program paying Medicare premiums and/or cost sharing
  • If you qualify for extra help paying for prescription drugs
  • If you enter, live in or leave a nursing home

The Medicare program rates how well health plans perform in different categories (for example, ratings in customer service and detecting and preventing illnesses). By visiting the website www.medicare.gov, you can compare the ratings for plans in your area by selecting “Find Health and Drug Plans.” You can also get a copy of our plans' ratings by calling us at 1-855-204-2744 (TTY 711) — 8 a.m. to 8 p.m., seven days a week.

Coverage Decisions & Appeals

Coverage decisions are decisions we make about whether a service is covered by the plan and the amount, if any, we are required to pay for the service. Coverage decisions are also called organization determinations. If you are not satisfied with the outcome of a coverage decision, you can appeal the decision by requesting a plan reconsideration. Learn more about coverage decisions and reconsiderations, and filing grievances. Call a customer service representative to get an aggregate number of grievances and appeals filed with BlueCross Total.

To request a coverage decision or reconsideration:

Call 1-855-204-2744 (TTY 711)
Fax your request to 1-803-264-9581
Email your request to medhelp@bcbssc.com
Download a reconsideration request form
You can name another person to act as your “representative” and ask for a coverage decision or reconsideration on your behalf, such as a friend, relative, doctor or other prescriber. To have a representative act on your behalf, both you and the representative must sign the Appointment of Representative form.

More Important Information

LIS Premium Summary Chart
Multi-Language and Non-Discrimination Policy
Beneficiary Rights and Responsibilities Upon Disenrollment
Our Privacy Practices

How to Contact Us

To Enroll: 1-800-930-2836 (TTY 711). Calls to this number are answered by a licensed insurance agent
Already a Member: Call our Customer Service representatives at 1-855-204-2744 between 8 a.m. – 8 p.m. (Eastern Time), seven days a week.
Address: Medicare Advantage, BlueCross BlueShield of South Carolina, P.O. Box 100191, Columbia, SC 29202-3191
Provider Services: 1-855-209-7267
Prior Authorization Fax: 1-803-264-6552
Mental Health: 1-800-868-1032

Submit feedback to Medicare about your BlueCross Total plan
Find out how the Medicare Beneficiary Ombudsman works for you
How to report fraud

BlueCross BlueShield of South Carolina does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status in our health plans, when we enroll members or provide benefits. Free language interpretation services are available for those who cannot read or speak English. To read our Non-Discrimination Statement and Foreign Language Access policy, click here.

BlueCross Total is a Medicare Advantage PPO plan with a Medicare contract. Enrollment in BlueCross Total depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on Jan. 1 of each year.

Out-of-network/non-contracted providers are under no obligation to treat BlueCross Total members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number, 1-855-204-2744, or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

Last updated: 10/07/2019
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