Blue Cross Blue Shield of Texas Gender Assignment Surgery and Gender Reassignment Surgery with Related Services. ... such as long-term cross-sex hormone therapy or surgical procedures, may render an individual infertile whether or not the individual has reproduced in the past. ...1 Internet/WiFi connection is needed for computer access. Data charges may apply when using your tablet or smartphone. Check your phone carrier’s plan for details. 2 Virtual Visits may be limited by plan. For providers licensed in New Mexico and the District of Columbia, Urgent Care service is limited to interactive online video; Behavioral Health service …Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield AssociationBlue Cross and Blue Shield of Texas (BCBSTX) would like to extend the opportunity to you for participation as a provider in the Blue Cross Medicare Advantage (PPO) plan. New individual providers and new medical groups desiring to apply for network participation or existing medical groups who wish to add additional providers to their … Sales Questions and Additional Plan Information: 1-888-731-0406. Calls may or may not be answered inside the United States. Monday – Friday: 8 a.m. – 8 p.m. CT Group Health Insurance Plans Built for Business. Your employees are your most valuable assets. Whatever the size of your business, health plans from Blue Cross and Blue Shield of Texas (BCBSTX) can help you create a healthier and more productive workplace that attracts and retains top talent. With health insurance plans that balance ...At Blue Cross and Blue Shield of Texas, we are committed to providing support to physician practices. We've designed useful tools for health care providers. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more. Availity ® Attachments: Submit Recommended Clinical Review ...Procedure Code Lists. Prior Authorization Procedure Codes List for Fully Insured Plans and Certain ASO Groups Effective 01/01/2024 (Includes changes effective 07/01/2024) Prior Authorization Procedure Codes List for Fully Insured Plans and Certain ASO Groups Effective 01/01/2023 -12/31/2023 (Includes changes effective 10/01/2023)Blue Cross Blue Shield of Texas - Health Insurance Texas. Get a free instant rate quote and apply online today for IL health insurance plans including individual and family health insurance, Medicare, short term health insurance and health savings account (HSA) compatible plans at www.bcbstx.com.Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield AssociationBlue Cross and Blue Shield of Texas. Attn: Complaints and Appeals Department. P.O. Box 660717. Dallas, Texas 75266-0717. Fax to 1-855-235-1055. Call BCBSTX at 1-888-657-6061 (TTY: 711) or email us at [email protected] if you have … Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association COVID-19 PHE Ends. We’re here to keep you informed about how the end of the COVID-19 public health emergency affects your benefit coverage. The Biden Administration ended the COVID-19 public health emergency on May 11, 2023. Some of your COVID-19 benefits have changed with the end of the public health emergency. Vaccines. Tests and Testing …Blue Cross and BlueShield of Texas contracts with ModivCare to provide NEMT to STAR members as a covered benefit through Texas Medicaid. Call 1-866-824-1565 between 8 a.m. and 5 p.m. Central Time, Monday through Friday, for more information about NEMT or to schedule a ride. Rides are available 24 hours a day, 7 days a week.Blue Cross and Blue Shield of Texas knows health care coverage in Texas — we invented it. We're Texas born and bred, and this is the only place we do business. We have been around for more than 90 years, and the cross and shield have come to represent the most experienced health care coverage organization in the state …Blue Cross and Blue Shield of Texas. Attn: Complaints and Appeals Department. P.O. Box 660717. Dallas, Texas 75266-0717. Fax to 1-855-235-1055. Call BCBSTX at 1-888-657-6061 (TTY: 711) or email us at [email protected] if you have …For telephone requests, please contact the appropriate Provider Customer Service Department number on the back of the member ID card or call 1-800-451-0287 . Upon completion of processing, telephonic requests for verification will receive a fax notice followed by a written notice via U.S. Mail. COVID-19 PHE Ends. We’re here to keep you informed about how the end of the COVID-19 public health emergency affects your benefit coverage. The Biden Administration ended the COVID-19 public health emergency on May 11, 2023. Some of your COVID-19 benefits have changed with the end of the public health emergency. Vaccines. Tests and Testing Sites. Baylor Scott & White Health (BSWH) is currently negotiating a new contract to cover care for patients with Blue Cross and Blue Shield of Texas (BCBSTX) health insurance. We …BCBSTX App: Blue Access Mobile ®. Our BCBSTX mobile app gives members easy access to the same information and tools as the online portal detailed above. In addition, the BCBSTX mobile app – available for iPhone and Android users – allows members to: Access a digital member ID card. Log in securely with Face ID (iOS only) and Fingerprint ID. Acceso a la cuenta | Blue Cross and Blue Shield of Texas. Pregunte. Solicite un folleto. Solicite un agente. Llámenos. Envíenos su pregunta para que un agente de seguros con licencia pueda comunicarse con usted. Nombre*. Apellido*. Teléfono*. The drug lists below are used with BCBSTX "metallic" health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans. If your company has 1–50 employees, your prescription drug benefits through BCBSTX are based on a Drug List, which is a list of drugs considered to be safe and effective. If you are a …Blue Cross and Blue Shield of Texas. ATTN: Complaints and Appeals Department. P.O. Box 660717. Dallas, TX 75266-0717. Call a Member Advocate for help filing an appeal at 1-877-375-9097 (TTY: 711) You must request an appeal by 60 days from the date your notice for denial of services was mailed. We will give you a decision on your appeal within ...Blue Cross Blue Shield of Texas | 3,444 followers on LinkedIn. Blue Cross Blue Shield of TexasIf you are in a crisis situation and need immediate help finding resources for care, call 1-800-252-8039 (TTY: 711) and ask to speak to a mental health clinician. BCBSTX Personal Health Assistants can help with changing appointments, finding a new provider or answering benefit questions.Prescription Drug Estimator & Pharmacy Finder. Use this tool to choose the right plan that covers your prescription drugs and pharmacy, estimate annual cost savings when you enroll, and find an in-network pharmacy near you. Get an.HealthSelect SM Secondary. For retirees and their eligible dependents enrolled in Medicare, visit HealthSelect MedicareRx for information about the HealthSelect Medicare Prescription Drug Program. For questions related to your prescription drug benefits, including diabetic supplies, call (866) 264-4676 (TTY: 711), 24 hours a day, seven days a week.In-Network Options. When receiving services from a lab, specialty pharmacy, or durable medical equipment (DME) provider, it's important to make sure that the provider is in your network. A laboratory must be in-network in the state your referring provider is located. A specialty pharmacy must be in-network in the state your ordering physician ...All Blue Cross and Blue Shield of Texas Silver plans offer the same set of health benefits, quality and amount of care. Your Silver plan options are different in how much you’ll pay each month, how much of your health care bill is covered for things like hospital visits and prescriptions and how much your out-of-pocket costs are: Silver plans have a monthly bill … Follow the prompts to join the Fitness Program. Or you can call the Fitness Program toll-free at (888) 762-BLUE (2583), Monday through Friday, 7 a.m. – 7 p.m. CT. Membership can be cancelled at any time by calling the Fitness Program toll-free at (888) 762-BLUE (2583). Earn 2,500 Blue Points for joining the Fitness Program and up to 300 ... Blue Cross Blue Shield of Texas Claims Overpayments Dept. CH 14212 Palatine, IL 60055-4212; Courier Address: Blue Cross Blue Shield of Texas Claims Overpayments Box 14212 5505 North Cumberland Ave., Ste. 307 Chicago, IL 60656-1471; Claims Status Inquiries. Payer ID – HCSVC; Appeals.You can get help with a mental health or substance use issue 24 hours a day, seven days a week. If you or your covered dependent are in a crisis situation, call (800) 252-8039 (TTY:711); the same number you call for medical and mental health benefits questions. The care management program also identifies participants that may benefit from extra ...COVID-19 PHE Ends. We’re here to keep you informed about how the end of the COVID-19 public health emergency affects your benefit coverage. The Biden Administration ended the COVID-19 public health emergency on May 11, 2023. Some of your COVID-19 benefits have changed with the end of the public health emergency. Vaccines. Tests and Testing …Blue Cross Blue Shield of Texas. Español. A simple, secure way to manage your care. Review your claims any time, anywhere. ... Blue Access for Members SM is a secure portal. You can find out about your health plan benefits, review your claims, and much more. You will need your ID card to sign up. The Personal Health Manager provides you with online information, resources, and tools to help you maintain your healthplan. You can use it to: Learn more about the Personal Health Manager. Login to the Personal Health Manager through Blue Access® for Members. See how BlueEdge fits your budget by using the HealthPlan Cost Estimator Tool. Blue Cross and Blue Shield of Texas (BCBSTX) would like to extend the opportunity to you for participation as a provider in the Blue Cross Medicare Advantage (PPO) plan. New individual providers and new medical groups desiring to apply for network participation or existing medical groups who wish to add additional providers to their …Blue Cross Blue Shield of Texas - Health Insurance Texas. Get a free instant rate quote and apply online today for Texas health insurance plans including individual and family health insurance, Medicare supplement, short term health insurance and health savings account (HSA) compatible plans at www.bcbstx.com. Compare and apply for Texas health insurance plans online at BCBSTX. Find individual and family, Medicare, short-term and HSA compatible plans and rates. The drug lists below are used with BCBSTX "metallic" health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans. If your company has 1–50 employees, your prescription drug benefits through BCBSTX are based on a Drug List, which is a list of drugs considered to be safe and effective. If you are a …Fax: (325) 794-2926. Claims: Send Claims Form to: Blue Cross and Blue Shield of Texas. PO Box 660044. Dallas, TX 75266-0044. Learn more about submitting medical and mental health claims. Fraud Hotline: Health care fraud affects health care costs for all of us.If you are in a crisis situation and need immediate help finding resources for care, call 1-800-252-8039 (TTY: 711) and ask to speak to a mental health clinician. BCBSTX Personal Health Assistants can help with changing appointments, finding a new provider or answering benefit questions.The Blue Premier network includes more than 94 hospitals and 7,600 providers. By choosing Blue Premier Access, clients choose more than just a health plan. They're choosing health coverage provided by Blue Cross Blue Shield of Texas, one of the most widely recognized health insurance companies in the state. Please fill out the form below and a Blue Cross and Blue Shield of Texas authorized agent will contact you within 1 to 2 business days. They will schedule an appointment at a time and location that is convenient for you. There is no cost or obligation for this service. Please select the product you are interested in HealthSelect SM Secondary. For retirees and their eligible dependents enrolled in Medicare, visit HealthSelect MedicareRx for information about the HealthSelect Medicare Prescription Drug Program. For questions related to your prescription drug benefits, including diabetic supplies, call (866) 264-4676 (TTY: 711), 24 hours a day, seven days a week.All Blue Cross and Blue Shield of Texas Silver plans offer the same set of health benefits, quality and amount of care. Your Silver plan options are different in how much you’ll pay each month, how much of your health care bill is covered for things like hospital visits and prescriptions and how much your out-of-pocket costs are: Silver plans have a monthly bill …Find a Doctor. Blue Cross Blue Shield members can search for doctors, hospitals and dentists: Select Blue Cross Blue Shield Global™ or GeoBlue if you have international …At Blue Cross and Blue Shield of Texas, we are committed to providing support to physician practices. We've designed useful tools for health care providers. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more. Availity ® Attachments: Submit Recommended Clinical Review ...If you're age 26 and losing coverage under a parent's plan, compare BCBSTX plans and find the right one for you. 1 Up to age 26 unless medically disabled. When you turn 26, it's considered a qualifying event. You must buy your own insurance now. Educate yourself on what you need in a health care plan and more at BCBSTX.For government programs claims, if you do not have online access, you may call provider customer service to check claim status or make an adjustment. Blue Cross Medicare Advantage SM — 1-877-774-8592. Texas STAR, CHIP — 1 …BCBSTX Mobile App. Features: Find a doctor, hospital or urgent care facility. Access your claims, coverage and deductible information. Ability to view and email your ID. Available in Spanish. Available for iPhone and Android users. To download the app, text* BCBSTXAPP to 33633 or search for BCBSTX in the Apple App Store or Google Play .Durable Medical Equipment Reimbursement Schedules / Prosthetics & Orthotics Reimbursement Schedules. 2024 Schedules effective 2/1/24. 2020 Schedules effective 3/1/20 - 1/31/24. 2017 Schedules effective 10/1/17 – 2/29/20. 2015 Schedules effective 11/1/15 – 9/30/17. 2014 Schedules effective 7/1/14 – 10/31/15. 2013 Schedules … About Us. Blue Cross and Blue Shield of Texas is a statewide, customer-owned health insurer. We believe Texas consumers and employers deserve the best of both worlds: access to affordable, quality health care and top-notch service from a company that focuses solely on customers, not shareholders. Customer value is our cornerstone. Blue Cross Blue Shield of Texas Claims Overpayments Dept. CH 14212 Palatine, IL 60055-4212; Courier Address: Blue Cross Blue Shield of Texas Claims Overpayments Box 14212 5505 North Cumberland Ave., Ste. 307 Chicago, IL 60656-1471; Claims Status Inquiries. Payer ID – HCSVC; Appeals.If you need help with things like changing appointments or finding a new provider, or you need a consultation with a mental health clinician, we’re here for you. Call 1-800-252-8039 (TTY: 711) to access free, confidential consultation services or to speak with a BCBSTX Personal Health Assistant. Learn more about Crisis Resources.BCBSTX Mobile App. Features: Find an in-network doctor, hospital or urgent care facility or search for Spanish-speaking doctors. Access your claims, coverage and deductible information. Access your temporary digital member ID card. Secure login with Face ID (iOS only) and Fingerprint ID. Payments on the Blue Access for Members Mobile App are here.To qualify for group coverage as a small business, your company needs between two and 50 full-time employees (including the owner). All full-time, permanent employees of an employer are eligible for insurance under a group policy. And 70% of eligible employees must select health plan coverage.The drug lists below are used with BCBSTX "metallic" health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans. If your company has 1–50 employees, your prescription drug benefits through BCBSTX are based on a Drug List, which is a list of drugs considered to be safe and effective. If you are a …Your Blue Cross and Blue Shield of Texas (BCBSTX) health insurance plan is ready for you. Get Started Using Your 2024 Health Plan Use these steps and make the most of …A Blue Cross and Blue Shield of Texas (BCBSTX) Medicare Supplement premium discount may be available. Read the eligibility criteria to see if you qualify. If you are eligible for a discount, the discount will be applied to your next bill and remain in effect as long as you are enrolled in your BCBSTX Medicare Supplement plan.Prior Authorization Requests for Medical Care and Medications. Some medical services and medications may need a prior authorization (PA), sometimes called a “pre-authorization,” before care or medication can be covered as a benefit. Ask your provider to go to Prior Authorization Requests to get forms and information on services that may ...Find a Doctor or Hospital. Know Your Network. Tips to Find a Doctor or Hospital. Find a Dentist. Utilization Management. Blue Distinction ® Specialty Care. Virtual Visits. Telemedicine and Telehealth Services. Sanitas Medical Center Collaboration.The drug lists below are used with BCBSTX "metallic" health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans. If your company has 1–50 employees, your prescription drug benefits through BCBSTX are based on a Drug List, which is a list of drugs considered to be safe and effective. If you are a …Blue Cross and Blue Shield of Texas. Attn: Complaints and Appeals Department. P.O. Box 660717. Dallas, Texas 75266-0717. Fax to 1-855-235-1055. Call BCBSTX at 1-888-657-6061 (TTY: 711) or email us at [email protected] if you have … Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association The Blue Cross Blue Shield System is made up of independent and locally operated companies. To access your member services, please visit your BCBS company. Find …6 days ago · Blue Cross and Blue Shield of Texas 1001 E. Lookout Drive Richardson, Texas 75082. General Information: 972-766-6900 TTD: 735-2989. Make a Payment. Mail your payment to the address on your premium invoice or learn about other convenient ways to pay your bill. Product and Program Contact Information Magellan Behavior Health Services coordinates all behavioral health (mental health and chemical dependency) services for Medicaid (STAR), CHIP, and STAR Kids members. Contact Magellan Health Services or call 1-800-788-4005. For prior authorization, benefits, eligibility, or claims status or questions contact Magellan at 1-800-327-7390.Health Care Service Corporation (HCSC) is a family of companies operating the Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. Texas Locations. Richardson — Headquarters 1001 E. Lookout Drive Richardson, Texas 75082 Main Switchboard: 1-972-766-6900 Travel Directions. Abilene 4002 E Loop 322 Abilene ...For telephone requests, please contact the appropriate Provider Customer Service Department number on the back of the member ID card or call 1-800-451-0287 . Upon completion of processing, telephonic requests for verification will receive a fax notice followed by a written notice via U.S. Mail.CDHP stands for Consumer Directed Health Plan. It's a type of health plan that gives you more control of your health care expenses. A CDHP most often pairs a Health Savings Account (HSA), or some other tax-advantaged account. An HSA is a savings account that lets you use pre-tax dollars to pay for a wide range of qualified …Get the latest from FEP. Be the first to know about our benefits, wellness incentives and rewards you're eligible for with your plan. Learn all about the #1 health insurance choice for federal employees, retirees and their families.Services include: An enhanced benefit for fashion eyewear for kids. Please see Enhanced Eyewear for Kids. If glasses or contacts are lost or stolen, contact customer service at 1-888-657-6061. Children may be able to have further eye tests and glasses as part of Texas Health Steps. To learn more about vision benefits, see the STAR Member Handbook.Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield AssociationClaims and Eligibility. This section presents an introduction to doing business with Blue Cross and Blue Shield of TX (BCBSTX), along with an overview of options and resources that may help you maximize administrative efficiencies in your office. The pages in this section are designed to follow the claim cycle — from the moment a BCBSTX ...Blue Cross and Blue Shield of Texas. ATTN: Complaints and Appeals Department. P.O. Box 660717. Dallas, TX 75266-0717. Call a Member Advocate for help filing an appeal at 1-877-375-9097 (TTY: 711) You must request an appeal by 60 days from the date your notice for denial of services was mailed. We will give you a decision on your appeal within ... Blue Cross Blue Shield of Texas - Health Insurance Texas. Get a free instant rate quote and apply online today for Texas health insurance plans including individual and family health insurance, Medicare supplement, short term health insurance and health savings account (HSA) compatible plans at www.bcbstx.com. Producers. Providers. Individual and family health insurance plans from Blue Cross and Blue Shield of Texas deliver outstanding coverage and service. BCBSTX is the leader in individual and family health insurance plans in Texas. Find a Pharmacy. If your Blue Cross and Blue Shield of Texas (BCBSTX) plan includes prescription drug coverage, select from the links below to search for a pharmacy: BCBSTX Prescription Drug Plans *. Medicare Plans *. Medicaid Plan: State of Texas Access Reform, STAR *. Medicaid Plan: Children’s Health Insurance Program, CHIP *.Blue Cross and Blue Shield of Texas. Attn: Complaints and Appeals Department. P.O. Box 660717. Dallas, Texas 75266-0717. Fax to 1-855-235-1055. Call BCBSTX at 1-888-657-6061 (TTY: 711) or email us at [email protected] if you have …Mail a personal check, money order or cashier's check to: Blue Cross and Blue Shield of Texas. P.O. Box 650774. Dallas, TX 75265-0774. Be sure you follow all instructions shown on your bill. Group Health Insurance Plans Built for Business. Your employees are your most valuable assets. Whatever the size of your business, health plans from Blue Cross and Blue Shield of Texas (BCBSTX) can help you create a healthier and more productive workplace that attracts and retains top talent. With health insurance plans that balance ... With three levels of coverage available, the MyBlue Health plan offers you a more affordable monthly payment with the same great support you’ve come to expect from BCBSTX. Plus, you might be able to get a premium tax credit, or subsidy, to lower your monthly bill payment. Even if you didn’t qualify in the past, you could receive one this year. Blue Cross Blue Shield of Texas - Health Insurance Texas. Get a free instant rate quote and apply online today for Texas health insurance plans including individual and family health insurance, Medicare supplement, short term health insurance and health savings account (HSA) compatible plans at www.bcbstx.com. Our customer satisfaction ratings are consistently above 96 percent. Focus on the member's needs, not just the question, and consider it their job to answer the "unasked" questions that may ultimately provide better assistance for the member. Have a solid track record of achieving first call resolution of members' needs more than 90 percent of ... To Complete Form go to Page 4. Use this form to authorize Blue Cross and Blue Shield of Texas (BCBSTX) to disclose your protected health information (PHI) to a specific person or entity. You may follow the instructions below or call the number listed on your Member ID card if you need help completing the form. You must complete the entire form.Telemedicine and Telehealth medical services and procedures are covered under some Blue Cross and Blue Shield of Texas (BCBSTX) PPO and HMO health care plans. If your health plan covers these services, you may get medical care from an in-network doctor or provider by mobile app, online video or phone. It can be helpful to learn about these ...
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Bookfi
Discount Program. Blue365 is just one more advantage of being a Blue Cross and Blue Shield of Texas (BCBSTX) member*. With this program, you and your family can save money on health care products — and services — that are most often not covered by your health plan. You'll see a full range of savings from top national and local …Discount Program. Blue365 is just one more advantage of being a Blue Cross and Blue Shield of Texas (BCBSTX) member*. With this program, you and your family can save money on health care products — and services — that are most often not covered by your health plan. You'll see a full range of savings from top national and local …CareFirst BlueCross BlueShield. Remote in Baltimore, MD 21224. $61,560 - $122,265 a year. Full-time. Easily apply. This role will serve as the face of our CareFirst BlueCross BlueShield government programs including Medicaid and Medicare in Eastern Maryland. Posted 30+ days ago ·. More...Blue Cross and Blue Shield of Texas. Attn: Complaints and Appeals Department. P.O. Box 660717. Dallas, Texas 75266-0717. Fax to 1-855-235-1055. Call BCBSTX at 1-888-657-6061 (TTY: 711) or email us at [email protected] if you have …Get links to current claim forms, understand how to submit claims to BCBSTX, read claim responses and use the Claim Review Form to submit adjustment requests. Also refer to the Provider Tools page on the provider website for convenient tools available. Claim Submission Forms. CMS-1500 User Guide & Tutorial. CMS-1500 Claims Filing Address.Producers. Providers. Individual and family health insurance plans from Blue Cross and Blue Shield of Texas deliver outstanding coverage and service. BCBSTX is the leader in individual and family health insurance plans in Texas.Baylor Scott & White Health (BSWH) is currently negotiating a new contract to cover care for patients with Blue Cross and Blue Shield of Texas (BCBSTX) health insurance. We …Blue Cross Blue Shield of Texas. Español. A simple, secure way to manage your care. Review your claims any time, anywhere. ... Blue Access for Members SM is a secure portal. You can find out about your health plan benefits, review your claims, and much more. You will need your ID card to sign up.In Austin, for example, Dell, Superior Healthplan, and Blue Cross Blue Shield currently operate. Superior, which covers 57% of the STAR and CHIP recipients in the …All Blue Cross and Blue Shield of Texas Silver plans offer the same set of health benefits, quality and amount of care. Your Silver plan options are different in how much you’ll pay each month, how much of your health care bill is covered for things like hospital visits and prescriptions and how much your out-of-pocket costs are: Silver plans have a monthly bill …In-Network Options. When receiving services from a lab, specialty pharmacy, or durable medical equipment (DME) provider, it's important to make sure that the provider is in your network. A laboratory must be in-network in the state your referring provider is located. A specialty pharmacy must be in-network in the state your ordering physician ....