Know Your Rights: Independent Reviews of Medical Necessity Decisions
As a BlueCross BlueShield of Tennessee member, you have the right to request a review by an independent, third party of medical necessity decisions. You can learn more about how your specific benefit plan handles requests for independent reviews in your benefit materials or Evidence of Coverage.
How Your Personal Information is Kept Private
Want to know how BlueCross BlueShield of Tennessee keeps your non-public personal information private? Review the company's Notice of Privacy Practices at www.bcbst.com/about/legal/hipaa/ HIPAA_privacy/ or call the Privacy Office at 1-888-455-3824 to find out more.
Improving the Quality of Care and Services
The safety, quality of care, and service that you receive as a BlueCross BlueShield of Tennessee member is important to you – and to us. That's why we have a Quality Improvement Program that is evaluated each year for:
• Quality of care and services our members receive
• Appropriateness of care our members receive
• Access to providers
Our program is recognized by well-known external accrediting bodies such as URAC and the National Committee for Quality Assurance (NCQA). In 2011, we received an "Excellent" rating and full accreditation from NCQA as well as full accreditation by URAC for our Case Management, Consumer Education and Support, and Health Plan with Health Utilization Management functions. For more information about our Quality Improvement Program, please send requests to: BlueCross BlueShield of Tennessee, Attn: Quality Management 2.4, 1 Cameron Hill Circle, Chattanooga, TN 37402.
Find a Doctor tool on bcbst.com
Did You Know? You can always find network providers using our Find a Doctor tool at bcbst.com or on the go with our new mobile website. While most providers will notify their patients if they leave our networks, you should always make sure your doctor is in the BlueCross BlueShield of Tennessee network before you make your next visit.
The best way to locate another provider is to use the Find a Doctor tool online. However, if you would like a provider directory sent to you or if you have questions, please call our Member Services Department, using the phone number listed on the back of your member ID card. Our office hours are Monday through Friday from 8 a.m. to 6 p.m. (Eastern).
Remember: using in-network doctors will help you save money!
Benefits After Mastectomy Annual Required Notice
Your BlueCross BlueShield of Tennessee health plan, as required by the Women's Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between the breasts, prostheses and the complications resulting from a mastectomy (including lymphedema). Please review your benefit plan materials for more details about these benefits and your coverage in general.
Notice of Information Privacy Policies and Practices
Purpose: This Notice informs consumers and customers that BlueCross BlueShield of Tennessee may disclose their nonpublic personal information the company collects to its affiliates but not to nonaffiliated third parties, except as permitted by law. Title V of the Gramm-Leach-Bliley Act (15 U.S.C. § 6801 et seq.) and the implementing regulations of the Insurance Commissioner of Tennessee require BlueCross BlueShield of Tennessee to deliver this Notice to consumers at their formation of customer relationships with the Company, and to its customers annually.
This Notice serves to inform you that BlueCross BlueShield of Tennessee does not disclose to nonaffiliated third parties your nonpublic personal information, which is collected and maintained as described below, except as permitted by law. The company will not disclose your nonpublic personal information to nonaffiliated third parties even after the customer relationship with you may end, except as permitted by law. BlueCross BlueShield of Tennessee reserves the right to disclose your nonpublic personal information the company collects during business transactions to its affiliates.
How information is protected: Except as explained below, BlueCross BlueShield of Tennessee restricts access to your nonpublic personal information to employees who need to know this information to provide its products and services to you. Such employees include claims processors, underwriters, and customer service personnel. The company maintains physical, electronic, and procedural safeguards that comply with legal requirements to guard your nonpublic personal information.
Collecting and maintaining information: BlueCross BlueShield of Tennessee collects nonpublic personal information about you from the following sources:
• Information received from you on applications or other forms;
• Information obtained from your transactions with the company, its affiliates or others.
Information the company discloses: BlueCross BlueShield of Tennessee discloses or reserves the right to disclose all of the nonpublic personal information the company collects and maintains about you to its affiliates.
The company may also disclose, and reserves the right to disclose, any of your nonpublic personal information to nonaffiliated third parties as permitted by law.
Companies that provide services or market on behalf of BlueCross BlueShield of Tennessee and its affiliated companies: The company may disclose the categories of your nonpublic personal information described in this notice to the following categories of nonaffiliated third parties with which the company and its affiliated companies contract to perform functions or services, such as marketing, on their behalf.
• Joint marketing partners
• Other financial institutions
• Other insurance companies
• Certain other third parties
No other disclosures to non-affiliated third parties: BlueCross BlueShield of Tennessee otherwise does not disclose nonpublic personal information about its customers or former customers to nonaffiliated third parties.
You do not need to call or do anything as a result of this notice. It simply informs you of how BlueCross BlueShield of Tennessee protects your nonpublic personal information.