Customer service and guidance

Speak with an expert today. It’s covered by your plan. If you’re not sure which number to call, check your Blue Shield member ID card.

Medicare Advantage members
(800) 776-4466

Medicare Advantage members in the California Public Employees Retirement System (CalPERS)
(888) 802-4599

Ask us anything about your plan and benefits seven days a week, 8 a.m. to 8 p.m. (CalPERS members, 7 a.m. to 8 p.m.)

• Learn about your coverage and costs

• Find a doctor, specialist, or mental health provider

• Get help with prescription coverage

• Find an urgent care facility, lab, or pharmacy

Let our Care Navigators make arrangements for you Monday through Friday, 8 a.m. to 4:30 p.m.

• Find appointments when your doctor is booked

• Get help with prior authorizations

• Arrange free transportation to appointments (for HMO members)

• Manage doctor referrals (for HMO members)

Dual Eligible Special Needs Plans (D-SNP) enroll people who qualify for both Medicare and Medi-Cal.

Care Coordinators are available from 8 a.m. to 6 p.m., Monday through Friday. It’s covered by your plan.
(800) 452-4413

Ask us anything about your plan and benefits seven days a week, 8 a.m. to 8 p.m.

• Find doctors, specialists, or mental health providers

• Register your account and use the app

• Help with prior authorizations

• Use your over-the-counter benefits

Let our Care Coordinators make arrangements for you Monday through Friday, 8 a.m. to 6 p.m.

• Coordinate your care between providers

• Schedule appointments

• Arrange for home care

• Access support for grocery and housing

• Book free rides to care

Your online account makes it easier for you to:

• Download your digital Blue Shield member ID card

• Check your benefits and costs

• Find doctors and specialists

Register online

Should I download the mobile app?

You can access your account information and ID card on the go with the Blue Shield of California app. It's available for both iOS and Android.

Learn more about our app

A referral is a request for an appointment from your primary care provider (PCP) to a specialist. A specialist is a professional who focuses on a specific disease or part of the body such as:

• Cardiologists who care for patients with heart problems

• Oncologists who care for patients with cancer

• Physical therapists who care for patients for joint or muscle problems

When do I need a referral?

• If you have an HMO plan, you'll need a referral from your PCP to see a specialist.

When do I not need a referral?

• If you have a PPO plan

• To receive emergency or urgent care

How does a referral work?

Referrals are often initiated during a visit with your PCP. You can also contact your provider to request a referral. Your provider will then send a referral to the specialist's office with relevant medical information.

Referrals may take a few days to be processed. The best way to know the status of your referral is to call your provider's office. Ask for the phone number of the specialist so you can call to make an appointment.

What if the specialist I'm referred to is booked?

Your provider may refer you to a specialist that has a very busy schedule. In this case, call Customer Service. We can help you find appointments with other specialists to get you care sooner.

Prior authorization is a request for pre-approval of certain tests, procedures, medical equipment, and medications ordered for you. Your provider must get that approval from Blue Shield before they proceed. The Blue Shield team will review the prior authorization request to ensure that Medicare covers everything and that the care meets the best available clinical research. Without this pre-approval, Blue Shield may not pay for your medication or medical procedure. You will then have to pay out of pocket.

Who starts the prior authorization process?

Typically, your provider starts the process by submitting a request on your behalf. It will include details about your diagnosis and why the test, procedure, equipment, or medication is needed. Prior authorizations usually take 1 to 3 days.

To know if your prior authorization has been processed, you have two options:

• Log in to your account. Under the "myblueshield" dropdown menu, select "Prior authorization." Here you can see a list of all prior authorization requests, as well as those that Blue Shield has approved.

• Call Customer Service. They can help determine the status of your prior authorization. They can also help move the prior authorization along faster.

What if my prior authorization is denied?

You have the right to appeal if Blue Shield denies your prior authorization request.

Learn more about Appeals and Grievances