Prescription Drug Claims Sample Clauses

Prescription Drug Claims. If You have Prescription Drug coverage, You pay for the drugs when You buy them and then You must file Claims to receive Benefits. To file, You must use the Prescription Drug Claim Form and have Your pharmacist sign it (or an attachment that We accept). After the form is completed, send it to Us at: Blue Cross and Blue Shield of Louisiana P.O. Box 98029 Baton Rouge, LA 70898-9029 When You receive other medical services (For instance, when You go to clinics or Provider offices), ask if the Provider has contracted with Blue Cross and Blue Shield of Louisiana. If so, this Provider will file Your Claim with Us. When Your Provider files on Your behalf, We will pay Your Provider based on Our contracted terms. However, in some instances, Providers may ask You to pay directly. If this occurs, get an itemized copy of the bill, be sure the Claim form is complete and correctly notes the following information: ◼ The Contract number (ID #) on the form must be the same as the number on Your ID card.‌ ◼ The patient’s full name. ◼ The patient’s date of birth. ◼ The patient’s relationship to the Subscriber. ◼ Dates of service ◼ Name and address of Provider of service. ◼ Diagnosis code ◼ Description of and procedure code for service ◼ The itemized charges for each procedure or service. Note: Statements, canceled checks, payment receipts and balance forward bills do not replace itemized bills. ◼ The Provider must mark the statement or Claim form PAID. Send completed Claim form to: Blue Cross and Blue Shield of Louisiana P.O. Box 98029 Baton Rouge, LA 98029-9029
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Prescription Drug Claims. Most Members with Prescription Drug coverage will not be required to file Claims to obtain Prescription Drug Benefits as this is done automatically when You present Your ID card to the Participating Pharmacist. However, if You must file a Claim to access Your Prescription Drug Benefit, You must use the Prescription Drug Claim form. The Prescription Drug Claim form, or an attachment acceptable to Us, may require the signature of the dispensing pharmacist. The Claim form should then be sent to Blue Cross Blue Shield of Louisiana’s Pharmacy Benefit Manager, whose telephone number should be found on Your ID card. Benefits will be paid to the Member based on the Allowable Charge for the Prescription Drug. When You receive other medical services (clinics, Provider offices, etc.) You should ask if the Provider is a Preferred or Participating Provider. If yes, this Provider will file Your Claim with Us. In some situations, the Providers may request payment and ask You to file. If this occurs be sure the Claim form is complete before forwarding to Blue Cross and Blue Shield of Louisiana. If You are filing the Claim the Claim must contain the itemized charges for each procedure or service. IMPORTANT NOTES: Statements, canceled checks, payment receipts and balance forward bills may not be used in place of itemized bills. Itemized bills submitted with Claim forms must include the following:
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Prescription Drug Claims. Please refer to the Prescription Drug Coverage section if you need to file a claim for Prescription Drugs. We must receive your claim no later than 12 months from the date of service. Exceptions may be made if you show you were not legally competent to file the claim. Claims will be processed in the order we receive them.
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Prescription Drug Claims 
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Related to Prescription Drug Claims

  • Prescription Drugs The agreement may impose a variety of limits affecting the scope or duration of benefits that are not expressed numerically. An example of these types of treatments limit is preauthorization. Preauthorization is applied to behavioral health services in the same way as medical benefits. The only exception is except where clinically appropriate standards of care may permit a difference. Mental disorders are covered under Section A. Mental Health Services. Substance abuse disorders are covered under

  • Prescription Safety Glasses Prescription safety glasses will be furnished by the employer. The employer retains the authority to establish reasonable rules and procedures regarding frequency of issue, replacement of damaged glasses, limits on reimbursement costs and coordination with the employer's vision plan.

  • Prescription Glasses This plan covers prescription glasses as follows: • Frames - one (1) collection frame per plan year; • Lenses - one (1) pair of glass or plastic collection lenses per plan year. This includes single vision, bifocal, trifocal, lenticular, and standard progressive lenses. This plan covers the following lens treatments: • UV treatment; • tint (fashion, gradient, and glass-grey); • standard plastic scratch coating; • standard polycarbonate; and • photocromatic/transitions plastic. This plan covers one (1) supply of contact lenses as follows: • conventional contact lenses - one (1) pair per plan year from a selection of • extended wear disposable lenses - up to a 6-month supply of monthly or two- week single vision spherical or toric disposable contact lenses per plan year; or • daily wear disposable lenses - up to a 3-month supply of daily single vision spherical disposable contact lenses per plan year. This plan also covers the evaluation, fitting, or follow-up care related to contact lenses. This plan covers additional contact lenses if your prescribing network provider submits a verification form, with the regular claim form, verifying that you have one of the following conditions: • anisometropia of 3D in meridian powers; • high ametropia exceeding -10D or +10D in meridian powers; • keratoconus when the member’s vision is not correctable to 20/25 in either or both eyes using standard spectacle lenses; and • vision improvement for members whose vision can be corrected two lines of improvement on the visual acuity chart when compared to the best corrected standard spectacle lenses.

  • Prescription Claims against the Issuer or any Guarantor for the payment of principal or Additional Amounts, if any, on the Notes will be prescribed ten years after the applicable due date for payment thereof. Claims against the Issuer or any Guarantor for the payment of interest on the Notes will be prescribed five years after the applicable due date for payment of interest.

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