Customer service and guidance

An online account makes it easier to manage your plan:

You can: 

• Download your digital Blue Shield member ID card

• Check your benefits and costs

• Find doctors and specialists

• See all your health records and perscriptions in one place.

Register online

The app makes accessing your account easier when you are on the go.  It’s the same information, but on your smartphone. It's available for both iOS and Android.

Learn more about our app

A referral is a request for an appointment from your primary care provider (PCP) to a specialist. A specialist is a provider who focuses on a specific disease or part of the body such as a heart doctor, surgeon or physical therapist:

When do I need a referral?

• If you have an HMO plan, you'll need a referral from your PCP to see a specialist.

When do I NOT need a referral?

• If you have a PPO plan

• To receive emergency or urgent care

How does a referral work?

Referrals are often initiated during a visit with your PCP. You can also contact your provider to request a referral. Your provider will then send a referral to the specialist's office with relevant medical information.

Referrals may take a few days to be processed. The best way to know the status of your referral is to call your provider's office. Ask for the phone number of the specialist so you can call to make an appointment after the referral has been processed.

What if the specialist I'm referred to is booked?

Your provider may refer you to a specialist that has a very busy schedule. In this case, call Customer Service. We can help you find appointments with other specialists to get you care sooner.

Prior authorization is a request for pre-approval of certain tests, procedures, medical equipment, and medications ordered for you. Your provider must get that approval from Blue Shield before they proceed. 

The Blue Shield team will review the prior authorization request to ensure that Medicare covers everything and that the care meets the best available clinical research. Without this pre-approval, Blue Shield may not pay for your medication or medical procedure. You will then have to pay out of pocket.

Who starts the prior authorization process?

Typically, your provider starts the process by submitting a request on your behalf. It will include details about your diagnosis and why the service or medication is needed. Prior authorizations usually take 1 to 3 days.

To know if your prior authorization has been processed, you have two options:

• Log in to your account. Under the "myblueshield" dropdown menu, select "Prior authorization." Here you can see a list of all prior authorization requests, as well as those that Blue Shield has approved.

• Call Customer Service or your doctor's office. They can help determine the status of your prior authorization. If you need help moving a prior authorization along call Customer Service to help.

What if my prior authorization is denied?

You have the right to appeal if Blue Shield denies your prior authorization request.

Learn more about Appeals and Grievances