How Do I...
Q1: Medical Plan FAQ's
A1: How do I receive the highest level of benefits for my medical claims?
Before you receive health care services, you should be sure that your health care provider is a network provider. It is your responsibility to check your provider’s network status, each visit, to ensure that you will receive the highest benefits your plan allows.
What if my doctor refers me to another provider that is not in the network?
It is your responsibility to check your provider's network status, each visit, to ensure that you will receive the highest benefits your plan allows. You can ask your doctor to refer you to another physician participating in the network.
What if I require emergency care?
If you require emergency care for a life- or limb-threatening emergency, seek care immediately at the nearest facility. The services you require will be covered at the highest benefit level of your plan. These situations include such conditions as serious burns, poisoning, convulsions, or severe difficulty breathing. You should contact your doctor within 24 hours, or the next working day. This helps to ensure that your doctor is fully aware of all medical episodes and can monitor you following the emergency situation.
What if I become ill while away from home traveling in the United States or abroad?
Your medical plan uses the BlueCard PPO program 
. With the BlueCard PPO program, your standard network benefit structure is available nationwide. Your ID card contains a "PPO in a suitcase" logo which identifies you as a member of the BlueCard PPO program. The program links together PPO network providers from Blue Plans across the United States. Call 1-800-810-BLUE (2583) for participating providers or visit bluecard.com . If you require medical services outside the United States, use BlueCard WorldWide participating providers . To locate one of these providers, call the BlueCard Worldwide® Service Center at 1-800-810-BLUE (2583) or collect at 1-804-673-1177 if you are unable to find a suitable provider. You may also visit bluecares.com to locate a participating provider.
Other than the benefit level, are there any differences in the medical plan if I use non-network providers?
Non-network health care providers can bill you for any difference between actual charges and the approved amount plus any charges for services deemed not medically necessary or not authorized by BlueCross BlueShield of Tennessee. For these reasons, it is very important to select a network provider whenever possible and to show your identification card to your doctor or hospital before you are admitted. The card contains information about the prior authorization requirements and also provides a toll-free number that providers may call for more information about your benefit plan.
Why did I receive a coordination of benefits letter in the mail?
Each year you will receive a coordination of benefits letter to verify if you or your eligible dependents have obtained or will obtain other medical insurance coverage. This coordination of benefits investigation procedure is a cost containment feature to prevent two insurance companies from making duplicate payments on the same charges, which in turn makes the cost of your insurance premium lower. It is important to keep your COB information current to avoid a delay in claims processing. When you receive a COB letter, fill it out and return it immediately, or you can update your COB information on the web at www.bcbst.com using BlueAccess.
What do the terms "medically necessary" or “medical necessity” mean?
Medical services received must be medically necessary to be covered by the plan. The services must be of proven value for use in the general population and must meet the following criteria;
- have final approval from the appropriate government regulatory bodies;
- have scientific evidence permitting conclusions concerning the beneficial effect of the service on health outcomes;
- improve the net health outcome;
- be as beneficial as any established alternative;
- demonstrate the improvement outside the investigational setting; and not be an experimental or investigational service.
What does the term “investigational” mean?
Investigational is defined as medical, surgical, diagnostic, psychiatric, substance abuse or other health care services, technologies, supplies, treatments, procedure, drug therapies or devices that are not approved by the appropriate regulatory agency as appropriate for the proposed use. Items or services classified as investigational are not covered by the insurance plan.
What about prior authorization? Who is responsible for this outside the BlueCross BlueShield of Tennessee network?
Please remember that certain services must have prior authorization. Most providers will handle this for you. However, outside the BlueCross BlueShield of Tennessee network, you should either call to initiate the process or follow up to make sure that it is done. For members who use the BlueCard PPO program, there is no mechanism for this plan to require the provider to write off benefit reductions or denials that occur as a result of failure to comply with prior authorization requirements. This means you will be responsible for any such reductions or denials. For prior authorization, providers may call the number listed on the back of your ID card. Members should contact member service at 1-800-245-7942 to verify prior authorization.
Should I be prepared to pay money at the time of service?
Network providers have the right to collect any deductible, copay, or coinsurance amounts on the date of service.
How can I find out what network my medical plan uses and if a doctor, hospital or other provider is in the network?
You can review the provider directory from this site. For medical providers in AL, AR, GA, KY, MS, MO, NC, TN and VA, select Blue Network P. Click here for providers in other states and be sure to select the PPO network option.
How can I find out what is covered under a benefit plan?
You can review plan benefits using BlueAccess at www.bcbst.com. BlueAccess allows you to review coverage information, benefits applied (including deductible and out-of-pocket balances), and other benefits information. If you prefer, you may call the BlueCross BlueShield TVA member service line at 1-800-245-7942 or ask your physician to submit a pre-determination request form describing the condition and treatment. The physician should send it to BlueCross BlueShield of Tennessee, Attention: Provider Service Center 2 West, 801 Pine Street, Chattanooga, TN 37402. BlueCross BlueShield of Tennessee will respond to confirm or deny benefits within three weeks.
How do I find out how much of the medical deductible or medical out-of-pocket has been met?
You can check the status of your deductible or out-of-pocket by using BlueAccess at http://www.bcbst.com/.
How can I find out what is covered under the preventive care allowance?
You (and each covered member of your family if you have family coverage) have an annual allowance of $250 per person per year to be used for routine physical expenses and preventive services as defined by the American Medical Association. The preventive care allowance is covered at 100% of allowable charges and is not subject to the annual deductible, copay, or coinsurance. Services include, but are not limited to, annual routine exams, pap smears, mammograms, PSA testing, etc. This applies to children age 6 and older and adults.
Well-Child care does not have a dollar limit. These exams are paid in accordance with the following generally accepted frequency based on the child's age.
- Prior to age one: 4 exams, in addition to the initial Physician exam in the hospital
- Between age one and prior to age two: 2 exams
- Between ages two and prior to age six: 1 exam per year
How do I file a medical plan grievance with BlueCross BlueShield of Tennessee and TVA?
Beginning 01/01/08, TVA members, or their representative, must file a Level 1 Grievance through BlueCross BlueShield of Tennessee prior to appealing through the TVA Joint Health Care Committee. A Member Grievance is a formal request for reconsideration of a denial of a claim or service. The member grievance can be filed by the member or a representative acting on their behalf. The member (or their representative) must complete a grievance form. The form can be obtained by calling the BlueCross BlueShield of Tennessee Customer Service department or by clicking here.
Q2: Other Program Options FAQ's
A2:
I have heard of a BlueCross BlueShield of Tennessee program called BluePerks® . As a TVA member, am I eligible to participate in this program?
Yes. BluePerks® is a program that features discounts on alternative medicine and wellness services not covered by a medical plan. For locations and phone numbers, call the BlueCross BlueShield of Tennessee BluePerks Discount Program CAM Service Center (1-800-227-5911). A list of alternative medicine practitioners can also be found on the BluePerks web page at http://www.bcbst.com/learn/blueperks/. There is also a paper listing available for those members who do not have Internet access.How do I find out more information about the services available through TVA’s Employee Assistance Program?
The Employee Assistance Program (EAP) offers confidential assistance to employees and their families to help them address a wide-range of personal problems. The EAP is designed to provide an assessment and referral service and where appropriate, a short-term counseling service. Employees and their dependents can have up to six (6) EAP sessions per incident at no personal cost.
TVA employees and dependents are also entitled to up to three (3) thirty minute office consultations or phone consultations, on separate legal matters per year and up to three (3) thirty minute office consultations or telephonic consultations with a financial planner each year. These consultations are free.
If the employee/dependent decides to retain an attorney, they will receive a 25% reduction in fees from the attorney’s customary hourly rate or $75.00 off financial plan preparation.
For more details on these services please contact Horizon Behavioral Services directly at 1-800-955-6422.How do I find out more about the services available through TVA’s Healthcare Assistance Program?
For information on this program, visit the eBenefits site on TVA’s Inside Net (available from within TVA) or visit www.myaccesshealth.com
All TVA employees and retirees have access to a Web site under this program for information on diseases, prescription drugs, and other health issues. This site-www.myaccesshealth.com
Two features of the site are the Decision Helper and the Live Assist sections. Decision Helper allows the user to review symptoms and respond to questions, leading to a recommendation on home treatment or to seek medical care. Live Assist is an on-line chat feature, in which the user can get assistance with searches on the site or get additional information on specific subjects. The chat feature is available from 11 a.m. to 8 p.m. Eastern time, seven days a week.
The site also allows you to create a personalized section tailored to your health interests. You can set up your own user name and password so your privacy is protected and create a personal account to receive e-mail about specific subjects and e-mail reminders of your health-care appointments.
You have access to a 24-hour nurse call line where you can talk to registered nurses who can answer many of your questions about medical conditions, your symptoms, or help you decide what to do when you don't know where to turn. You can reach a nurse 24 hours a day by calling toll-free 1-877-598-3972 (1-800-793-7044 TTY).
If you have a medical condition, you may be eligible for care-management services under this program. This feature may provide a specialized nurse available by phone to provide you with information and support to help you follow your doctor's treatment plan.
Q3: BlueCross BlueShield of Tennessee Member Service, Claims, and other Administrative FAQ's
A3:
How do I contact BlueCross BlueShield Member Service?
Member Service can be reached at 1-800-245-7942 between 8:00 AM and 5:15 PM EST Monday through Friday.How do I request additional identification cards?
You can request identification cards using the BlueAccess site or you may call the BlueCross BlueShield TVA member service line at 1-800-245-7942.How can I add or remove dependents from my benefit plans?
If you need to add or remove a dependent, you must contact the TVA Service Center in Knoxville at 632-8800, in Chattanooga at 751-8800, or toll-free at 1-888-275-8094.How do I change my home address information?
All address changes must be submitted through TVA. Employees can change their home addresses through TVA’s Self Service Solutions or by calling the TVA Service Center in Knoxville at 632-8800, in Chattanooga at 751-8800, or toll-free at 1-888-275-8094. Retirees should submit address changes in writing to the TVA Retirement System at 400 West Summit Hill Drive, WT 8A, Knoxville, Tennessee 37902.
How can I get information on a claim that has been filed?
You can get information on claims and print explanations of benefits (EOB) using BlueAccess which allows you to check claims status and review other important benefit information.What if I have questions about the charges or services shown on a claim or EOB or if I disagree with the payment that was made on my claim?
You can call the Member Service line at 1-800-245-7942. The Member Service Representative will assist you in explaining the way your claim was handled and, if necessary, can send your claim for further review.Where should I file a paper medical claim?
Most claims are filed electronically by your physician or hospital facility. In States other than Tennessee, use the BlueCard Program to search for a participating provider. BlueCard providers agree to file the claim for you as well and accept contract rates and discounts. However, should you need to file a claim yourself, claims should be submitted to BlueCross BlueShield of Tennessee, Attn: Member Benefits Administration, P.O. Box 180150, Chattanooga, TN 37401.Where should I file a paper dental claim?
Most claims are filed electronically by your network dental provider. However, should you need to file a claim yourself, claims should be submitted to BlueCross BlueShield of Tennessee, Attn: Member Benefits Administration, P.O. Box 180150, Chattanooga, TN 37401.How are BlueCard PPO claims filed?
As long as you use a BlueCard PPO network provider, the provider will be responsible for filing the claim. This claim will be filed to the local BlueCross BlueShield Plan where the provider has a network agreement. You should always make sure that your provider has your most current ID card and that they file the claim with the 3-digit alpha prefix.How can I get copies of the explanations of benefits for claims that have been processed?
You can print duplicate EOB's using BlueAccess at site.
Q4: Prescription Drug Benefit FAQ's
A4: How can I find out if a particular medication is covered under my plan and how much it will cost?
You can find out about your prescription-drug benefits administered through Medco from this site. After you register with the Medco site, you can review your plan coverage, price medications, and review other information on prescription drugs, health and wellness. If you prefer, you may call Medco’s customer service at 1-800-818-0890.
How can I find out if there’s a generic substitution for a particular drug?
You can find out about your prescription-drug benefits administered through Medco from this site . After you register with the Medco site, you can review your coverage and other information on drugs, including whether or not a generic is available for a particular drug. If you prefer, you may call Medco’s customer service at 1-800-818-0890.
How can I find out if a particular medication must be purchased through home-delivery?
You will have to order certain maintenance medications in 90-day supplies through Medco’s home-delivery service after you purchase the medication three times at your local pharmacy. You can find out if a particular medication must be ordered through home-delivery from this site . After you register, select “Benefit Highlights” for information on retail and home-delivery coverage. You can enter the name of the medication to see if it must be ordered through the home-delivery service. If you prefer, you may call Medco’s customer service at 1-800-818-0890
Q5: Health Reimbursement Account (HRA) FAQ's
A5:
How can I find out what the available balance is in my health reimbursement account (HRA)?
If you are a member of the Consumer-Directed Health Plan, you can access your health reimbursement account balance information by logging in to BlueAccess at www.bcbst.com and selecting Member Self-Service.Who do I call to ask questions about my health reimbursement account (HRA) balance?
Only employees participating in the Consumer-Directed Health Plan have health reimbursement accounts administered through BlueCross Blue Shield of Tennessee. For information on your account, you should call Blue Cross BlueShield’s member service line at 1-800-245-7942.
Q6: Dental Plan FAQ's
A6: What are the differences in the dental plan if I use a non-network provider?
Claims submitted by a non-network provider are processed based upon the average billed amount in the area where the services were performed. Also, by using a non-network dental provider you will not receive any network discounts, and the provider may bill you for any differences between the actual charges and the paid amount plus any charges for services deemed not clinically necessary.
How can I find out what network my dental plan uses and if a dentist or oral surgeon is in the network?
For dental providers, click here and select dentist from the options menu and then choose DentalBlue as the network for Tennessee and contiguous counties. Select DenteMax as the network for other states.
Why did I receive a coordination of benefits letter in the mail?
Each year you will receive a coordination of benefits letter to verify if you have obtained or will obtain other dental insurance coverage. This coordination of benefits investigation procedure is a cost containment feature to prevent two insurance companies from making duplicate payments on the same charges, which in turn makes the cost of your insurance premium lower. It is important to keep your COB information current to avoid a delay in claims processing. When you receive a COB letter, fill it out and return it immediately, or you can update your COB information on the web at www.bcbst.com using BlueAccess.
Am I required to receive a prior authorization on any dental services?
No prior authorization is required on any dental services. However, your provider may file a Predetermination of Benefits. The Predetermination of Benefits program allows you and your dentist to know exactly what kinds of treatment are covered. Once the Predetermination of Benefits is processed, you and your dentist will be notified what benefits are available, and what payments, if any, you must make. Dental predetermination requests should be sent to: BlueCross BlueShield of Tennessee, Attention: Dental Department, P. O. Box 180150, Chattanooga, TN 37401-7150
How do I file a dental plan grievance with BlueCross BlueShield of Tennessee and TVA?
Beginning 01/01/08, TVA members, or their representative, must file a Level 1 Grievance through BlueCross BlueShield of Tennessee prior to appealing through the TVA Joint Health Care Committee. A Member Grievance is a formal request for reconsideration of a denial of a claim or service. The member grievance can be filed by the member or a representative acting on their behalf. The member (or their representative) must complete a grievance form. The form can be obtained by calling the BlueCross BlueShield of Tennessee Customer Service department or by clicking here.
