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Trio by Blue Shield FAQ

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The following FAQ provides information aboutthe new Trio health plan from Blue Shield. For a complete description of your Stanford benefits, please refer to the Plan Summary Documents in the Resources section on the Cardinal at Work website. If there are discrepancies between this information and the Plan documents, Plan documents govern.

What doctors can I see with the Trio medical plan?

Trio uses a select Blue Shield of California network of doctors and hospitals (the Trio ACO HMO provider network). The plan’s service area includes the following Bay Area counties: San Francisco, San Mateo, Santa Clara, Alameda, Contra Costa, Santa Cruz and parts of Marin. Several Southern California counties are also included. Explore the Trio network on the Blue Shield of California website.

I read that the Trio plan includes access to Shield Concierge; what is that?

The Shield Concierge team includes health advocates, registered nurses, health coaches, pharmacists, pharmacy technicians, clinical support coordinators, and dedicated customer service representatives. This team provides personalized support on all aspects of your care, including benefits, claims, providers, pharmacy, health coaching, care coordination, case management, and more.

The Shield Concierge team can:

  • Help you find a Trio network provider
  • Work with you and your doctor to coordinate care across all providers
  • Help you manage a chronic condition, such as asthma, diabetes, or coronary artery disease
  • Connect you with NurseHelp 24/7
  • Explain pharmacy benefits coverage, including formulary use
  • Assist you with claims, and much more

If you have any questions about your health plan benefits, call Shield Concierge at 855-747-5800, 7 a.m. to 7 p.m. Pacific time, Monday through Friday.

Do I need to select a PCP in the Trio network?

Yes. You can choose a PCP or have one assigned to you. PCPs perform preventive care and treat medical conditions. They also coordinate other health care, including referrals to specialists and hospitals within their medical group/Independent Practice Association (IPA). Each member of your family can choose a different physician and medical group/IPA.

To find a PCP in the Trio network:

You will need your selected PCP’s ID number when you enroll in the Trio HMO plan for the first time through My Benefits.
To find this number, click on your doctor’s name and select View details under “Primary Care Physician ID.”

What happens if I don’t select a PCP when I enroll in the Trio plan?

If you don’t select a PCP during Open Enrollment, Blue Shield will automatically match you and any enrolled dependents with one based on your ZIP code. To change your PCP, just call your Shield Concierge team.

How can I find out if my current doctor is in the Trio network, so I can select my doctor as my PCP?

Use the look-up tool on the Blue Shield website:

  • Go to blueshieldca.com/networktriohmo
  • Select Primary Care Physician
  • Enter your location, and then click Continue
  • Select Doctor Name
What if my current doctor is not in the Trio network?

If your doctor is not in the Trio network, you can search for a new one at https://www.blueshieldca.com/fad/home.

If I need to see a specialist, do I need a referral from my PCP?

Yes. If you want to pay your regular plan copayment to see a specialist, you will need a referral from your PCP before seeing a specialist.

If your PCP participates in our Trio+ Specialist program, you may go directly to a specialist within your physician’s medical group/IPA without a referral. You will pay a slightly higher copayment. Medical groups/IPAs that participate in the Trio+ Specialist program are identified in our online directories and on your Blue Shield member ID card.

If your PCP does not participate in the Trio+ Specialist program, you will need a referral from your doctor to see a specialist.

Can I self-refer to an OB/GYN?

Trio HMO plan members can self-refer to an OB/GYN within their medical group/IPA for any OB/GYN-related services. You do not need a referral, and you will not have to pay an additional copayment.

What if I’m new to the Trio plan, and I’m receiving care from a provider who is not in the Trio network?

If you are currently receiving care – for planned surgeries, pregnancy and newborn care, acute and serious chronic conditions, or a terminal illness – from a provider who is not in the Trio network, please call Shield Concierge to see if continuation of care is available to you during your transition to the Trio plan.

If I already have authorization for a medical procedure, but it takes place after my Trio coverage goes into effect, do I need to get a new authorization?

Yes. If you have been scheduled for treatment that required authorization from your former doctor, who is not in the Trio network, you will need new authorization from a doctor who is in the Trio network. If you have questions, please call Shield Concierge.

Do I have coverage while traveling outside of California or the U.S.?

When you’re outside California or out of the country, you and your family can get urgent and emergency care through the BlueCard and Blue Shield Global Core programs. These programs offer access to doctors and hospitals almost everywhere in the U.S. and in 170 countries and territories around the world.

To find a provider in the U.S., visit provider.bcbs.com, or call 800-810-BLUE. To find a provider outside the U.S., visit bcbsglobalcore.com, or call collect 804-673-1177 from outside the U.S.

My children are going to college outside California. How do they access care while they are away from home?

The Away From Home Care program gives students, long-term travelers, workers on long-distance assignments, and families living apart flexible coverage across most of the country for extended periods of time. The Away From Home Care program is not available in all areas and states. Benefits from the host plan may differ from benefits in the Trio HMO plan. To find out whether your family is eligible, call Shield Concierge.

Does Trio cover acupuncture, chiropractor and massage treatment?

Yes. With the Alternative Care Discount Program, you can save on alternative healthcare services from practitioners participating with American Specialty Health Group, Inc. Just make an appointment with a participating practitioner and show your Blue Shield member ID card at your appointment to get your discount.

To find a participating provider in the Alternative Care Discount Program:

  • Go to blueshieldca.com/networktriohmo
  • Select Alternative Medicine
  • Enter your location, and then click Continue
  • Under Doctor Type, select Alternative Care Discount Program

You can also call American Specialty Health Group, Inc. at 888-999-9452, Monday through Friday, 5 a.m. to 6 p.m. Pacific time.

Services in the Alternative Care Discount Program include:

Acupuncture services
Members receive 25% off the usual and customary fees for services including:

  • Examinations
  • Acupuncture or electro-acupuncture
  • Adjunctive therapeutic procedures

Chiropractic services
Members receive 25% off the usual and customary fees for services including:

  • Examinations
  • Manipulative treatment
  • Adjunctive therapeutic procedures
  • X-rays
  • Supports and appliances

Massage therapy
Members receive 25% off the usual and customary fees for massage therapy visits. A variety of techniques may be used including:

  • Swedish massage
  • Deep-muscle massage
  • Deep-tissue massage
What are Trio’s prescription drug tiers?

Drugs in a formulary are typically grouped into tiers based on defined categories. The tier that your medication is in determines your portion of the drug cost. A typical drug benefit includes three or four tiers: Tier 1 usually includes generic medications. You can find information about what you pay by drug tier in your health plan documents.

The column titled “Tier” identifies the cost level you pay for a drug.

Tier Description
1

Typically, generic drugs and some brand drugs

2

Typically, preferred brand drugs and some generic drugs

3

Typically, non-preferred brand drugs and some generic drugs

4

Specialty drugs or select drugs priced greater than $600 per month

*All drugs are reviewed for clinical and therapeutic safety and effectiveness. Not all drugs priced greater than $600 will be placed in Tier 4.

Does the Trio plan have an app?

The Blue Shield mobile app gives you quick and easy access to important health plan information anytime, anywhere.

With the Blue Shield mobile app, you can:

  • View your Blue Shield member ID card
  • Find a doctor, hospital, or urgent care center
  • Get benefits information*
  • View deductible and copayment year-to-date totals
  • View claims
  • Access NurseHelp 24/7
  • Contact us

*See your health plan documents or check with your company’s plan administrator for your specific benefit coverage.

It’s easy to get started. From your phone, download the Blue Shield of California mobile app today from the App StoreSM or Google PlayTM. Be sure to log in with your username and password to get the most from the app experience.