Patient Advocates for Capital Blue Cross - Find one today.
Supporting and empowering Capital Blue Cross patients across Central Pennsylvania.
Capital Blue Cross has served Central Pennsylvania residents since 1938, but mastering their authorization protocols and appeal structure can feel like trying to cross the Susquehanna River without a bridge. Your Solace advocate understands the specifics of Capital Blue Cross policies—from securing prior approvals to challenging claim denals and coordinating specialty care across their regional network. They'll organize the paperwork volume, handle the follow-up calls, and remove the administrative barriers so you can focus on your health instead of battling with insurance requirements.
Best of all, most patients pay nothing out of pocket.
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About
Capital Blue Cross operates as a major health insurance provider in Central Pennsylvania, serving about 1 million members across 21 counties. With Pennsylvania roots dating back to 1938, Capital Blue Cross offers various health insurance plans including PPO, HMO, Medicare Advantage, and Vision Care options through their regional provider networks. While they provide access to healthcare facilities throughout Central Pennsylvania and connections to national providers through the BlueCard program, members face challenges with their county-specific authorization requirements and multi-level appeal process. Their prior approval system requires exact documentation and timing, with members tracking authorization status through the Capital Blue Cross Connect portal. For appeals, Capital Blue Cross follows a structured review process that aligns with Pennsylvania insurance regulations, creating obstacles for members contesting denied claims or services.
What problems can a Capital Blue Cross patient advocate help you with?
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Get the clarity you need to make sense of your care and take charge of your health.
We’ll make the calls (and the callbacks) so you can spend more time doing what you love.
Keep your care affordable with lower medical bills and access to local financial help.
Advocates review coverage, handle preauthorizations, and even help with appeals.
Stay on top of the cutting-edge treatment options and leave no stone unturned.
Advocates coordinate your care team so your health never falls through the cracks.
Get the tools and answers you need to make informed decisions about your care.
Advocates help you overcome your healthcare hurdles—no matter how big they might be.
Solace has helped over 14,000 patients and families
Rose G.
04/01/2024
Eric H.
08/07/2024
Joan H.
05/01/2024
Stephen I.
04/27/2024
Jonathan J.
06/05/2024
Anne J.
07/27/2024
Capital Blue Cross Appeals with a Patient Advocate
Managing Capital Blue Cross's appeal system requires deep knowledge of their specific requirements. Capital Blue Cross maintains a structured process with distinct stages—using specific forms, submission protocols, and review timelines that frustrate many patients. Your Solace advocate builds strong appeals that meet Capital Blue Cross standards, gathers critical medical evidence, and presents your case using language that aligns with their review criteria. They monitor deadlines and guide your appeal through the correct channels, whether you need a standard review or must progress to an external review through the Pennsylvania Insurance Department.
Beyond appeals, your Solace advocate serves as your guide through the entire Capital Blue Cross system. They help you obtain required authorizations before procedures to prevent denials, explain how to optimize your benefits within their network, and coordinate communication between your healthcare providers and Capital Blue Cross review teams. When facing network constraints, they help you find in-network specialists or request exceptions when medical necessity exists. They also decode your benefits package to uncover hidden coverage options, from home health services to programs for chronic conditions. In every interaction, they convert insurance terminology into clear language so you can make informed health decisions.
Your Solace advocate slices through Capital Blue Cross's administrative maze, capturing the benefits you've paid for and rightfully deserve.
The Solace care team model
With Solace, you get both a patient advocate and a supporting physician, which we refer to as your “care team”.
Your advocate will be there to manage the day to day aspects of your care: coordinating with doctors, researching potential solutions and communicating updates to you.
Your supporting physician can unlock resources for you and your advocate that might otherwise be out of reach.
We’ve Got Answers
Still unsure how an advocate can help? Explore these answers to the questions we’re asked the most.
How are Solace advocates qualified to help?
Advocates on Solace are experienced physicians, nurses, pharmacists, and other healthcare professionals from a wide range of backgrounds. 98% of Solace patients report better healthcare outcomes after working with an advocate.
What else can a Solace advocate help me with?
What can a Solace advocate not do?
We know our advocates sound like miracle workers, but they have limits. They can’t prescribe medications or diagnose an illness, for instance. They can’t replace your doctor, but they can break down the barriers standing between you and the quality care you deserve.