You have the right to ask Blue Cross of Idaho Care Plus to pay for items or services you think should be covered. This is called an "organization determination" (also called a coverage decision).
An organization determination (referred to here as a coverage decision) is a decision Blue Cross of Idaho Care Plus makes about your benefits and coverage and whether we will pay for the medical services you or your doctor have requested. You can also contact us to ask for a coverage decision before you receive certain medical services. You might want to ask us to make a coverage decision beforehand if your doctor is unsure whether we will cover a particular medical service or if your doctor refuses to provide medical care you think you need.
You, your representative, or your doctor can ask us for a coverage decision by calling, writing, or faxing your request to us.