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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.

Be Assured of Fair Decisions About Care

BlueCross BlueShield of Tennessee works hard to earn and keep your trust. Whenever possible , we want to be an open book about how we make decisions. For prior authorizations and other health care decisions, we look at two factors: whether the care or service suggested is appropriate for your condition and whether your plan covers it. Denying care, service or coverage is not rewarded in any way to anyone whether employees, vendors or contracted practitioners by BlueCross.

Improving Your Quality of Care and Services

Your safety, quality of care, and the services 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 service
  • Appropriateness of care
  • Access to providers

Our program is Nationally recognized by two external accrediting bodies, URAC and the National Committee for Quality Assurance (NCQA). For more details about our Quality Improvement Program, please send requests to: BlueCross BlueShield of Tennessee, Attn: Quality Management 2.3, 1 Cameron Hill Circle, Chattanooga, TN 37402.

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 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 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 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 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 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; and
  • Certain other third parties.

No other disclosures to non-affiliated third parties: BlueCross 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 protects your nonpublic personal information.

 
 
BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association