Ambulance services An OK from us is not needed for emergency ambulance transport
- A licensed ambulance company
- An emergency
- Personal Care Services - CFC - All qualified members may receive medically and functionally necessary Personal Assistance Services under CFC.
- Acquisition, maintenance and enhancement of skills - All qualified members may receive this service to enable the member to accomplish ADLs, IADLs and health-related tasks.
- Emergency Response Services - CFC - (Emergency call button) - All qualified members may receive necessary emergency response services under CFC.
- Support Management - All qualified members may receive voluntary training on how to select, manage and dismiss attendants.
- not invasive
- done to find out what is wrong
- ordered and done by (or under the guidance of) your provider
- Visits to doctors, specialists or other providers
- Well exams
- Medical equipment given for use in the home
- Medically necessary
- Within the limits of what is covered by Medicaid
- Emergency room
- Ambulance services
- Medical visits for birth control
- Marriage and family planning, education and counseling services
- Birth control medications, including long acting reproductive contraception (LARC)
- Nursing services
- Personal care services
- Hospital room with two or more beds
- Nursing care
- Operating room
- Surgery
- Anesthesia
- Respite Care;
- Supported Employment;
- Financial Management Services;
- Adaptive Aids;
- Employment Assistance;
- Flexible Family Support Services;
- Minor home modifications; and
- Transition Assistance Services.
- Care that has to do with pregnancy
- Care for any female medical condition
- One well-woman checkup per year
- Orthotic braces, splints or ankle and foot supports
- Covered when medically necessary
- Dialysis
- Giving you someone else’s blood
- Medical problems of the feet
- Medical or surgical treatment of disease, injury or defects of the foot
- Pregnancy
- After-delivery care when medically necessary
- Newborn exams
- BCBSTX uses Medicaid/CHIP Vendor Drug Program's (VDP) preferred drug list
- Most generic and over-the-counter drugs are covered
- Developmental assessments
- Physical, occupational or speech therapy
- Routine shots
- Lab tests
- Comprehensive Care Program services for members 20 years and under
- DME
- Home health and other medically necessary services
- Human organ and tissue transplants that are not still being tested
- All corneal, bone marrow and peripheral stem cell transplants that are not still being tested
Is Blue Cross Blue Shield of Texas the same as Blue Cross Blue Shield?
BCBSTX is a Division of Health Care Service Corporation (which operates Blue Cross and Blue Shield plans in Texas, Illinois, Montana, Oklahoma and New Mexico), the country's largest customer-owned health insurer and fourth largest health insurer overall.
Does Blue Cross Blue Shield Texas cover gym memberships?
If you are a Blue Cross and Blue Shield of Texas (BCBSTX) member, the Fitness Program is available exclusively to you and your covered dependents (age 16 and older). The program gives you access to a nationwide network of fitness locations.
Does Blue Cross Blue Shield Texas cover telehealth?
In response to the COVID-19 pandemic, BCBSTX expanded access to telemedicine/telehealth services to give our members greater access to care. Members can access their medically necessary, covered benefits through providers who deliver services through telehealth.
Does BCBSTX follow Medicare guidelines?
Medicare Marketing Guidelines
All providers who contract with Blue Cross and Blue Shield of Texas (BCBSTX) to provide Medicare Advantage services are expected to abide by the Centers for Medicare & Medicaid Services (CMS) rules for marketing when it involves BCBSTX or Blue Cross Medicare Advantage products or benefits.