BlueCross BlueShield of Tennessee wants you to have the personalized, quality health care you deserve. For that to happen, it is important that you understand how your health plan works, and that you become involved and informed about the care you receive. As a plan member, you have certain rights, responsibilities, and expectations. By understanding and upholding these rights and responsibilities, you will help us arrange and coordinate the type of care you deserve.

Members have the right to:

• Be treated with respect and dignity and need for privacy
• Expect that any information they give to their practitioner or to the plan will be treated in a confidential manner
• Receive services without discrimination due to age, sex, race, color, religion and national origin
• Receive information about policies and services of their plan network, including structure, operation, quality improvement activities and member rights and responsibilities
• Receive information regarding the practitioners in their plan network
• Receive medically necessary and appropriate care
• Receive information regarding health care and access to medical records as stated in federal and state laws
• Request medical records be corrected as stated in federal and state laws
• Participate with practitioners in making decisions about their health care
• Voice appeals, grievances or complaints about their health care practitioners, the care they receive, or their plan network, with the expectation of an answer within a reasonable timeframe. They also have the right to formally appeal this answer if it is not acceptable to them.
• A candid discussion of appropriate medically necessary treatment options for their condition, regardless of cost or benefit coverage
• Formulate a living will (or advance directive)
• Approve (consent) or deny an employer access to member-identifiable health information
• Be informed about the associated cost of care
• Make recommendations regarding the organization's member rights and responsibilities policy

Members are expected to:

• Consult their practitioner for all medical services to be covered by the plan
• Provide, to the extent possible, all information concerning their health to those providing their health care
• Follow the instructions and advice of those providing their health care services, or immediately question what they do not understand or do not agree with
• Show their member identification (ID) card each time they seek health care
• Ensure that they are the only person who uses their ID card. (A parent or legal guardian must present the ID card for dependents under the age of 18 each time health care is sought)
• Notify the plan if there is a change in employment, address or dependents
• Keep health appointments and call the health caregiver's office to cancel if they cannot make the appointment
• Treat their caregiver with respect and dignity
• Read the benefit booklet, Evidence of Coverage
• Pay any copayment, deductible, coinsurance, or any charges for non-covered and out-of-network services if required as part of the member's health plan
• Be a part of decision making about their health care
• Seek understanding of their health benefit plan and their responsibility to pay for out-of-network services they agree to receive