Does my plan cover COVID-19 testing?
Yes, Blue Shield of California Promise Health plan Medi-Cal and Cal MediConnect members have no costs associated with COVID-19 screening or testing. This includes:
- COVID-19 screenings performed:
- Virtually using telehealth (including Teladoc)
- In a doctor’s office
- At an urgent care center
- In a hospital (including emergency room (ER))
- COVID-19 testing that’s recommended by a doctor and provided by a health care professional
There are no prior approvals needed for COVID-19 screening or testing.
What if I need treatment for COVID-19?
There are no prior approvals needed for COVID-19 medical treatment. Currently, there is no specific medication to prevent or treat coronavirus disease. Blue Shield Promise Medi-Cal and Cal MediConnect members have no out-of-pocket costs for medical treatments.
There are no copays, coinsurance, and deductibles for COVID-19 medical treatments. This applies to the following plan types:
- Blue Shield Promise Medi-Cal
- Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
To find out which plan you have, call the Member Services number on your member ID card.
What virtual care options does my plan cover?
If you have a fever, cough, or feel short of breath, we suggest using a virtual care option such as Teladoc or the Nurse Advice Line before seeking in-person care. This will help reduce the risk of spreading the virus. Teladoc visits and the Nurse Advice Line are always available at no additional cost. The doctors and nurses speak English and Spanish. Interpretation services for other languages are available upon request.
- With Teladoc, you can talk to a doctor 24/7 by phone or video to screen for the virus. To setup an appointment or register, either:
- Log in to your online account, or
- Call 1-(800)-Teladoc (835-2362) [TTY: 711]
- You can also talk to a registered nurse anytime with Nurse Advice Line at 1-800-609-4166 [TTY: 711].
You can also call your primary care physician (PCP) for advice, and they may be able to see you virtually. If your doctor recommends testing for COVID-19, they can tell you where to go to get tested.
What if I seek care from a non-network provider for COVID-19? Will it be covered?
In the case of a medical emergency, care provided by in network and out-of-network providers will be covered for all plans.
Blue Shield Promise Medi-Cal
Out-of-network providers are those that do not have an agreement to work with Blue Shield Promise Health Plan. Except for emergency care, you may have to pay for care from providers who are outside of the network. If you need covered health care services, you may be able to get them outside of the network at no cost to you as long as they are medically necessary and not available in the network and you get prior approval. If you need help with out-of-network services, for:
- Los Angeles County members please call 1-800-605-2556 [TTY: 711] 8 a.m. to 6 p.m., Monday – Friday.
- San Diego County members call (855) 699-5557 [TTY: 711] 8 a.m. to 6 p.m., Monday – Friday
Blue Shield Promise Cal Medi Connect Plan
If you need medical care that Medicare and/or Medi Cal requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out of-network provider. Your Primary Care Physician (PCP) is responsible for submitting the request for prior authorization for out of network services. You must obtain an authorization from the plan or your PCP’s affiliated medical group prior to seeking care from an out of network provider. In this situation, you will pay the same as you would pay if you got the care from a network provider.
What if I need to refill my prescriptions?
If you are worried you might run out of prescribed medications, Blue Shield Promise Health Plan allows early refills on your prescriptions as long as there are refills available with your prescription. If you have specific questions about the medicine you take, call the Member Services number on your member ID card.
To meet your needs and promote social distancing, many retail pharmacies are waiving fees for home delivery of prescriptions. Visit your pharmacy’s website or call your local pharmacy for more information. Also, if available, utilize the drive-thru window when picking up your prescriptions.
Medi-Cal members can also fill a prescription for up to a 100-day supply of medications at retail pharmacies or through our mail service pharmacy. Call your doctor to switch to a 100-day prescription and to ask about mail service pharmacy.
CalMediConnect members can also fill a prescription for a 90-day supply of maintenance medications at retail pharmacies or through our mail service pharmacy. Call your doctor to switch to a 90-day prescription and to ask about mail service pharmacy. Learn more about Cal-MediConnect pharmacy benefits.
Can I continue seeing my mental health care provider?
If you are currently seeing a mental health care provider, you can continue to see that provider virtually, such as over the phone or by video.
What resources are available to help me manage stress and my health while at home?
Blue Shield Promise Cal MediConnect plan members can use their Blue Shield Promise account login information to access Sanvello at Wellvolution.com. Sanvello, a mental and wellness health app in our Wellvolution® program network that helps members manage stress, anxiety, and depression, is providing expanded access and premium programming for members through 7/31/2020. All content – 45 different mindfulness and meditation sessions, coping tools, guided journeys, and community boards – is available at no cost during the COVID-19 public health emergency.
In addition to Sanvello’s mental health resources, our virtual Wellvolution programs also provide nutrition and fitness support to help you eat better, move more, and even treat chronic conditions like diabetes.
Please note: Medi-Cal plans do not have access to Wellvolution. Please call Member Services for eligibility information.
Questions about medical or prescription coverage?
Call the number on your member ID card.