Call 1-888-494-2583 (TTY 1-800-377-1363). Hours are:
8 a.m. - 8 p.m.
Oct. 1 - Mar. 31, Seven days a week
Apr. 1 - Sept. 30, Monday - Friday
For fast (expedited) coverage decisions, call the same number at 1-888-494-2583 (TTY 1-800-377-1363).
Fax 1-208-387-6811 You may contact us by fax for expedited coverage decisions.
Write Blue Cross of Idaho Care Plus, P.O. Box 8406, Boise, ID 83707
When we give you our decision, we will use the "standard" deadlines unless we have agreed to use the "expedited" (fast) deadlines. A "fast coverage decision" is called an "expedited determination."
Standard coverage decision A standard coverage decision means we will give you an answer within 14 days of receiving your request.
Expedited (fast) coverage decision If you think your health could be seriously harmed or that you could lose your ability to function by waiting the standard 14 days for a decision, you can ask for an "expedited" (fast) decision. We will give you an answer within 72 hours of receiving your request for a fast coverage decision.
To get a fast coverage decision, you must meet two requirements:
If your doctor tells Blue Cross of Idaho Care Plus that your health requires a "fast coverage decision," we will automatically agree to give you a fast coverage decision
If you ask for a fast coverage decision on your own, without your doctor's support, we will decide whether your health requires that we give you a fast coverage decision.
We can take up to 14 more calendar days to make either a standard or fast decision if you ask for more time or if we need information (such as medical records from out-of-network providers) that may benefit you. If we decide to take extra days to make the decision, we will tell you in writing.
If you believe we should not take extra days, you can file a “fast complaint” about our decision to take extra days. When you file a fast complaint, we will give you an answer to your complaint within 24 hours.
If we do not give you our answer within the standard or fast time (or if there is an extension at the end of that period), you have the right to appeal. You also have the right to file an appeal if you disagree with our coverage decision.
In some cases we might decide a service is not covered or is no longer covered by your plan. If we say no to part or all of what you requested, we will send you a detailed written explanation as to why we said no and instructions on how to appeal our decision.