CareFirst BCBS does not cover outpatient services?

Hello,

I need some help in interpreting why my insurance claims were denied. For context, I have a CareFirst BCBS EPO Basic plan provided by my insurance, no deductible, no copay, and according to the benefits summary provided by my employer, it states that Primary Physician Office Visit and Preventative Care I pay $0, and Outpatient lab work is covered at 100%.

I had a visit with my doctor about 2 months ago for a general check up, and during that check up he noted that I had abnormally high blood pressure for someone my age. He recommended a followup visit where if it was still high consistently after I tracked it for a month, we would do a set of blood tests to rule out any external factors like diabetes, cholesterol issues, endocrine issues, and potential tumors. Well, it was still high so on that second visit I did 5 blood tests, a urine test, and I was also behind on my tdap shots so I did that too. Fast forward to last week, and I get the insurance back for my second visit and see that they didn’t cover anything besides one of the blood tests that the hospital had to send out (all the charges had code B315 in my EOB).

I was confused as I thought this was all routine preventative care, so I sent them a message asking what the issue was. They replied saying “This is a facility claim for outpatient hospital services. Unfortunately, there is no coverage for these services with your EPO Basic policy.”

I don’t understand, so no outpatient services are at all covered? I can’t go to see the doctor to monitor my health? There was no mention of this at all on my benefits summary when I chose my insurance, so I could have never known, and now I’m stuck with this policy until December. I’m going to contact my HR rep tomorrow and ask them for guidance, but in the meantime I wanted to ask here if this was normal to have a health insurance plan that wont cover followup visits and any lab work/vaccines done during that time because they are outpatient care?