Covered Services
You do not need a referral from your PCP for the following services:
- Emergency care
- Behavioral Health issues
- OB/GYN services
- Dental services
The care listed below will be covered through B – UFC/ALTCS. Some services may have limitations and/or require a prior authorization, contact your Case Manager or the Customer Care Center for more information:
- Ambulance for emergency care
- Behavioral Health Care
- Pregnancy care
- Case management
- Checkups for children, pregnant women, QMB, and SMI members
- Children's services including routine dental care
- Chiropractic services for children and QMB
- Dialysis
- Diet and health teaching
- Disease Management
- Durable Medical Equipment (DME)
- Emergency or Urgent Care medical treatment
- Eyeglasses or contacts for children, or adults only after cataracts are removed
- Family planning / birth control
- Health care services through screenings, diagnosis and medically needed treatments for members 21 years of age or older
- Hospice care
- Home and Community Base Services (HCBS) and Assisted Living Facilities (ALF)
- Hospital care
- Lab work and x-rays
- Limited dental services (members over the age of 20)
- Medical tests
- Medically needed foot care done by a licensed Podiatrist. A Podiatrist may provide foot care for members when ordered by a PCP.
- Medicine from the approved drug list, the B – UFC/ALTCS Drug Formulary
- Organ transplants
- Orthotics
- PCP office visits
- Preventative and routine gynecological services for female members (no referral needed)
- Private Nursing Care
- Transportation to health care visits
- Speech, Physical and Occupational Therapies
- Second opinions: You have the right to have a second opinion from a qualified health care professional within the network. If one is not available in the network, you have the right to ask for a second opinion outside the network at no cost to you
- Skilled nursing home care
- Supplies and equipment, including B – UFC/ALTCS Drug Formulary diabetic testing equipment and supplies
- Well-child checkups including dental, hearing, shots and vision care
Important Information Related to RSV and Synagis
B – UFC/ALTCS is pausing prior authorization requirements this season for Synagis® (palivizumab). Effective November 15, 2022, prior authorization for Syangis is not required. This is effective for the remainder of the 2022-23 RSV season.