When you need inpatient hospital care
If you need to be hospitalized, you will receive the highest level of benefits when you choose a preferred hospital.
Prior authorization and pre-admission review
In the event of a hospital admission, please do the following:
- For an emergency admission, you or your physician must notify Blue Shield within 24 hours or as soon as reasonably possible
- For a non-emergency admission, you or your physician must notify Blue Shield at least five business days before the planned hospitalization date
- Contact Us to verify that the inpatient treatment or procedure that you expect to receive is covered by your health plan
Except in an emergency, failure to notify Blue Shield in advance of your hospitalization will result in a fee in addition to the copays and deductibles outlined in your Evidence of Coverage (EOC) or Certificate of Insurance (COI).
Inpatient services outside of California
If you need hospitalization when you are outside of California and outside of the United States, your inpatient hospital service benefits are covered at the same level as when you go to a Choice preferred hospital here in California.
The hospital will contact us to confirm your coverage and will bill Blue Shield of California for your covered inpatient hospital services. What you pay for covered hospital services are the Choice hospital copays and deductibles outlined in your EOC/COI.
If you need inpatient physician services (such as physician visits) surgery and anesthesia administration are usually billed separately from inpatient hospital services.
You must pay for all other physician services you receive at hospitals outside the United States at the time you receive those services, and then submit a claim within one year of the month you receive those services.
Foreign claims in another language must be translated into English, with dollar amounts reflecting the current exchange rate.
We will notify you of our coverage decision within 30 to 45 days of receiving a complete claim.
Contact Us: If you have any questions about foreign claims, including what information they should contain, please don't hesitate to contact us.
Whenever you receive care outside of California, you should notify your regular physician when you return, so he or she can provide any necessary follow-up care.
When you need outpatient surgery
There are ambulatory surgery centers within our preferred network that can save you money when you need outpatient surgery.
For your plan, there may be lower copays for having outpatient surgery in a preferred ambulatory surgery center versus a hospital facility. To see the cost differences, refer to your Evidence of Coverage (EOC) or Certificate of Insurance (COI).
To help lower your health care costs, you may want to discuss ambulatory surgery centers with your physician when you need outpatient surgery.
To locate a preferred ambulatory surgery center:
- Use Find a Doctor
- Check your printed copy of our "Preferred & Select Physician, Hospital, Urgent Care and Ambulatory Surgery Center Directory"
- Contact us