2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare
Professionals


Note: The calendar year deductible applies to almost all benefits in this Section. We say "(No deductible)" when it does not apply.
 
Benefit Description

Lab, X-ray and Other Diagnostic Tests
Diagnostic tests, such as:
  • Laboratory tests (such as blood tests and urinalysis)
  • Pathology services
  • EKGs
  • Cardiovascular monitoring
  • EEGs
  • Neurological testing
  • Ultrasounds
  • X-rays (including set-up of portable X-ray equipment)
  • Bone density tests
  • CT scans*/MRIs*/PET scans*
  • Angiographies
  • Genetic testing*
*Prior approval is required
 
  • Notes:
     
    • Benefits are available for specialized diagnostic genetic testing when it is medically necessary to diagnose and/or manage a patient’s existing medical condition. Benefits are not provided for genetic panels when some or all of the tests included in the panel are not covered, are experimental or investigational, or are not medically necessary. Refer to the next paragraph for information about diagnostic BRCA.
       
    • You must obtain prior approval for BRCA testing (see page 43). Diagnostic BRCA testing, including testing for large genomic rearrangements in the BRCA1 and BRCA2 genes: Benefits are available for members with a cancer diagnosis when the requirements in the note above are met, and the member does not meet criteria for Preventive BRCA testing. Benefits are limited to one test of each type per lifetime whether covered as a diagnostic test or paid under Preventive Care benefits (see pages 43-44).
       
    • See pages 43-44 in this Section for coverage of genetic counseling and testing services related to family history of cancer or other disease.
       
  • Nuclear medicine
  • Sleep studies
Note: See Section 5(c) for services billed for by a facility, such as the outpatient department of a hospital.


You Pay
Preferred: 30% of the Plan allowance

Note: $0 member cost-share for the first 10 laboratory tests performed in each of these different laboratory test categories (Basic metabolic panels; Cholesterol screenings; Complete blood counts, Fasting lipoprotein profiles; General health panels; Urinalysis) and 10 Venipunctures when not associated with preventive maternity or accidental injury care.

Non-preferred (Participating/Non-participating): You pay all charges

Note: When care is provided by a Non-preferred laboratory and/or radiologist, as stated on page 18 for an exception, you pay:

 
  • Participating laboratories or radiologists: 30% of the Plan allowance
     
  • Non-participating laboratories or radiologists: 30% of the Plan allowance, plus any difference between our allowance and the billed amount
 

List Item:

calendar
deductible
lab
laboratory
x-ray
diagnostic
tests
blood
urinalysis
pathology
EKGs
Cardiovascular
monitorig
EEGs
Neurological
ultrasounds
bone
density
CT
MRIs
PET
scans
angiographies
genetic
prior
approval
BRCA
BRCA1
BRCA2
breast
cancer
gene
counseling
nuclear
sleep
outpatient