Sports medicine specialist carefirst blue cross blue shield

If you think you need to see a specialist

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CareFirst BlueCross BlueShield’s Patient-Centered Medical Home keeps high-risk patients healthier, resulting in fewer hospital admissions and shorter stays, while saving $267 million
Is CareFirst the same as Blue Cross Blue Shield?
Does CareFirst require authorization?
Is CareFirst the same as United Healthcare?
Does CareFirst cover IVF?

A specialist is a Doctor that has been trained as an expert in certain diseases or areas of the body. For example, an orthopedic specialist treats broken bones, joints and other problems related to bones and the skeleton.

Your Primary Care Physician (PCP) will suggest a specialist when needed. He will give you a referral. This is a written order given to you to see a different doctor.

Self Referral Services

In some cases you may be able to seek treatment without a note from your primary care provider. You can find a list of these services under Referrals and Authorizations or you can call Enrollee Services at (202) 821-1100 or (855) 326-4831

When you must have a written approval

When you need special care, like a hospital admission or surgery, you need approval before you can get them. This is to be sure that you are getting the care you need and that is right for your condition. Your Doctor or Enrollee Services must be contacted.

CareFirst BlueCross BlueShield’s Patient-Centered Medical Home keeps high-risk patients healthier, resulting in fewer hospital admissions and shorter stays, while saving $267 million

CareFirst BCBS’s PCMH initiative1 includes more than 4,000 primary care providers (PCPs) and nurse practitioners – more than 80 percent of all PCPs in the CareFirst service area, which includes parts of Northern Virginia, the District of Columbia and Maryland. These participating providers are coordinating care for approximately 1.1 million CareFirst members. PCPs can practice in established groups or “virtual” panels that help enable accurate quality and financial measurement and provider “peer-review” of one another’s performance. The model includes an immediate double-digit increase in the primary care fee schedule and new payments for care plans for chronically ill members. Participating providers are eligible for additional fee increases based on performance. CareFirst local care coordinators partner with PCMH practices to help coordinate care, such as assuring post-discharge coordination, making physician office visits to discuss patients’ care plans, and providing regular web-based updates to a record available to the entire care team.

RESULTS

CareFirst has seen the overall rate of increase in medical care spending for its members slow from an average of 7.5 percent per year, in the five years preceding the program’s launch, to 3.5 percent in 2013. Beyond the encouraging overall medical care spending trends, CareFirst continues to see strong performance by its PCMH program when measured against the expected cost of care for CareFirst members covered by the program. Healthcare costs for the 1.1 million CareFirst members covered by PCMH were $130 million less than projected in 2013; 3.2 percent less than the expected cost of care for this population of patients. The savings has risen from 1.5 percent in 2011 and 2.7 percent in 2012. In all, the PCMH Program has accounted for $267 million in avoided costs when measured against the projected cost of care from 2011 to 2013.

Key quality indicators suggest positive impacts on CareFirst members who are under the care of PCMH primary care providers. The company tracks key quality indicators for those members who see participating PCMH physicians and members who see physicians who are not in the PCMH program. When compared to members under the care of non-PCMH physicians, CareFirst members seeing PCMH providers had (*Per 1,000 CareFirst Members):

6.4% fewer hospital admissions
11.1% fewer days in the hospital
8.1% fewer hospital readmissions for all causes
11.3% fewer outpatient health facility visits

1July 2014. CareFirst BlueCross BlueShield press release

Serving Maryland, CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. an independent licensee of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. Group Hospitalization and Medical Services, Inc., and First Care, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst BlueCross BlueShield, CareFirst MedPlus, and CareFirst Diversified Benefits are the business names of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). The aforementioned legal entities (excepting First Care, Inc. of Maryland), CareFirst BlueChoice, Inc., and The Dental Network, Inc., are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. CareFirst of Maryland, Inc. CareFirst Community Partners, Inc. and The Dental Network, Inc. underwrite products in Maryland only.

“World’s Most Ethical Companies” and “Ethisphere” names and marks are registered trademarks of Ethisphere LLC.

Is CareFirst the same as Blue Cross Blue Shield?

of Maryland), CareFirst BlueChoice, Inc., and The Dental Network, Inc., are independent licensees of the Blue Cross and Blue Shield Association.

Does CareFirst require authorization?

All inpatient services require authorizations. All outpatient services in the below categories and/or outpatient services and procedures by a non-par facility or non-par provider require an authorization. Authorization is not a guarantee of payment.

Is CareFirst the same as United Healthcare?

Starting January 1, 2022, CareFirst replaces UnitedHealthcare (UHC). You may be wondering what programs are staying, what other changes are coming, and what is staying the same. The following chart outlines your current benefit and wellbeing programs and what they look like in 2022.

Does CareFirst cover IVF?

Treatment of infertility including artificial insemination and In‑Vitro Fertilization (IVF) requires authorization from CareFirst in all settings. Treatment of infertility when performed in a specialist's office requires a written referral from the PCP.