Search results with tag "Bcbsla"
Preventive Care Services - bcbsla.com
www.bcbsla.comThe Preventive & Wellness benefits in effect are those required by state or federal law for your policy, at the time the services are rendered. To the extent this Preventive Care Services document conflicts with state or federal requirements, state and federal requirements control. What kinds of preventive and wellness services are covered for you
Covered Drug List - bcbsla.com
www.bcbsla.comCovered Drug List 04HQ1509 R09/21 HMO Louisiana, Inc. is a subsidiary of Blue Cross and Blue Shield of Louisiana. Both companies are independent licensees …
Medical Expense Claim - bcbsal.org
www.bcbsal.orgMEDICAL EXPENSE CLAIM FILL OUT A SEPARATE FORM FOR EACH PATIENT. Use this form to file a claim for any eligible medical expenses when your physician or other provider does not file a claim. Please print clearly with black ink or type. 1. Patient’s Name (only one Patient per form) 2. Contract Number as shown on your I.D. Card
Prescription Drug Claim Form - bcbsal.org
www.bcbsal.orgCL-94 (Rev. 4-2015) Front . INSTRUCTIONS Remember to always show your Blue Cross and Blue Shield ID card and ask for the Claim Authorization Number when purchasing a prescription drug. Please read these instructions carefully before entering your prescription drug claim