Introduction

BlueAdvantage Choice, BlueAdvantage Gold, and BlueAdvantage Platinum

BlueAdvantage Choice, Gold, and Platinum combines the benefits of Medicare Part A and B and includes additional services not covered  by Original Medicare plus it offers Medicare Part D prescription drug coverage.  It is a unique program in that members may use any doctor, specialist, or hospital that accepts the BlueAdvantage Terms and Conditions of Plan Payment.

Prior to providing services to a BlueAdvantage Member, Providers must agree to the Terms and Conditions of Plan Payment.  When Providers choose to extend services to a BlueAdvantage Choice, Gold, or Platinum Member, they are acknowledging their agreement and are “deemed” to have a contract with BlueCross BlueShield of Tennessee.

Providers who are aware they are treating a BlueAdvantage Choice, Gold, or Platinum Member and decline to accept the Terms and Conditions of the Plan must only do so if the services are extended on an urgent or emergency basis.

BlueAdvantage Complete

BlueAdvantage Complete is a Special Needs Product (SNP) for full dual eligibles effective January 1, 2007.  BlueAdvantage Complete combines the benefits of Medicare Part A and B and includes additional services not covered by Original Medicare plus it offers Medicare Part D prescription drug coverage.  It is a unique program in that Members may use any doctor, specialist, or hospital that is contracted on our SNP Network.  Members will only receive out of network benefits for emergency or urgent care.  As a BlueCross BlueShield of Tennessee contracted network, providers will not be required to accept the Terms and Conditions of Plan Payment, rather they will adhere to the contracted fee schedule.

Page Modified:May 21, 2012