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Blue Shield of CaliforniaUsing a Blue Shield of California card for virtual outpatient treatment.
Blue Shield of California PPO cards and self-funded employer plans administered by Blue Shield are among the most common cards we read. Yours is specific to your employer and your plan year. We read it before you commit to anything.
Shift is out of network with Blue Shield of California.
We are not part of any commercial carrier network, and we say so on every page. Many PPO plans still pay a real share of out-of-network behavioral health care. We read your plan, tell you what it pays toward intensive outpatient care, and give you the number before your first appointment.
What we can say about your plan before we read it.
Covered by many PPO plans. We check your benefits first.
We do not waive cost shares, we do not tell you a number we have not verified, and we do not promise a result. We read your plan, we tell you what it pays toward intensive outpatient care, and you decide after that.
What your plan sets, and what we do about it.
The numbers are not on this page on purpose. Yours are specific to your plan and your plan year, and we pull them with you.
What your plan document sets
- An allowed amount for each kind of visit or day of care.
- A deductible you meet before the plan starts paying its share.
- A coinsurance split that applies after the deductible.
- An out-of-pocket maximum for the plan year.
- An authorization step for intensive outpatient care.
What we do
- Call the behavioral health number on the back of your card and pull the out-of-network figures for the level of care you need.
- Turn those figures into the dollar cost of a week of treatment and give you that number in writing.
- Open the authorization and stay on the case through review and renewal.
- Bill the plan directly, so you are not fronting the claim and chasing a reimbursement.
Blue Shield and Blue Cross are not the same card.
California is the only state where a member can hold either of two Blue cards, and the behavioral health benefit is not read the same way on both. If you are not sure which one you hold, read the logo on the front and we confirm the rest on the call.
You want the Anthem page
Anthem Blue Cross of California is a different card from Blue Shield of California, with a different behavioral health line to call. Start there instead.
Anthem Blue Cross California If the logo says Blue ShieldSend the member ID and the group number
They are on the front of the card. That is enough for us to pull the out-of-network behavioral health figures and tell you what a week of intensive outpatient care would cost you.
Check your benefitsBlue Shield of California, answered plainly.
Is Shift part of the Blue Shield network?
No. We are out of network with Blue Shield of California and with every other commercial carrier. That is a statement about contracts, not about whether your plan pays anything. Many PPO plans pay a substantial share out of network, and we read yours and tell you the figure.
Do I have to pay the whole bill and claim it back?
No. We bill the plan directly on your behalf, so you are not fronting a claim and chasing a reimbursement. What you owe is the cost share your own plan document sets.
My employer self-funds and Blue Shield just processes the claims. Does that change anything?
It changes who writes the rules. The employer's plan document sets the benefit and the administrator applies it. We read the plan document and the benefit the same way, and we tell you if the two disagree.
Can I attend from anywhere in California?
Yes, as long as you are physically in California during every session. Our clinicians are licensed here, and California telehealth rules follow where the patient is, not where the clinician is.
Send us the Blue Shield card and we read the plan.
The member ID and the group number on the front are enough to start. We come back with your out-of-network deductible, coinsurance and out-of-pocket maximum, and what a week of intensive outpatient care would cost you. Nothing is committed until you decide.
If you or someone you are with is in immediate danger, call or text 988 (the Suicide and Crisis Lifeline) or call 911. Shift Support Network is an outpatient program and is not an emergency service.
Not the card you hold.
Shift also publishes a page for Anthem Blue Cross California, Aetna, Cigna, UnitedHealthcare, UMR, Carelon, Magellan, Kaiser and union and Taft-Hartley funds.
Background reading: how out-of-network works, out-of-network for IOP and PHP in plain English, and the program itself.