BlueCross BlueShield of TN

You have the right to:

  1. Get information about us, like our services, the providers* and practitioners in our networks, and your member rights and responsibilities.
  2. Be respected and treated with dignity, and have your private information kept private.
  3. Make your own decisions about your health care based on an open, honest discussion with your health care providers and practitioners about all your treatment options, regardless of cost or whether your plan covers them.
  4. Make complaints or appeals about us or your care.
  5. Recommend changes to our member rights and responsibilities policy.

You have the responsibility to:

  1. Give us and your health care providers the details we need (as much as possible) to provide care that's right for you.
  2. Follow directions you and your providers have agreed to about your treatment.
  3. Work with your health care providers to understand your conditions and decide on a treatment and goal that you can agree on.

    4. To learn more about your rights and responsibilities, go to bcbst.com/memberrights

* The National Committee for Quality Assurance (NCQA), an independent organization that offers accreditation for insurance companies, defines “providers” as facilities where you get care, and “practitioners” as people who provide care. In some documents, we use the term “providers” to refer to both.


 

Getting Fair Decisions About Your Care

When we make decisions about what care we'll cover, our number one concern is your health. BlueCross BlueShield of Tennessee is a Qualified Health Plan Issuer in the Health Insurance Marketplace. We look at two things when we make these decisions:

  • Is the requested care or service right for your condition and overall health?

  • Does your plan cover it?

 

Independent Reviews of Our Decisions About Your Care

Most of our members have the right to ask that someone else — who doesn’t work for BlueCross — review medical necessity decisions we make. You can learn more about how we handle these reviews in the Grievance or Appeals section of your Evidence of Coverage (EOC). You should have gotten your EOC when you signed up, but you can find it anytime by logging in to your bcbst.com account. Call us at 1-800-565-9140 if you’d like us to send you a new copy.


 

Health and Wellness

We give you resources to help improve and manage your health. To learn more about these resources, log in to bcbst.com or call 1-800-565-9140.


 

Making Sure You Get Quality Care





Every year, we look at the care our members receive to make sure you're getting:

  • High-quality care and services

  • Care that's right for you

  • Access to high-quality providers, hospitals and other facilities

We've earned national accreditation from two independent organizations, URAC and the National Committee for Quality Assurance (NCQA). If you'd like to know more about our quality programs, write to us at:

BlueCross BlueShield of Tennessee
Attn: Quality Management 2.3
1 Cameron Hill Circle
Chattanooga, TN 37402


 

Your Care and Benefits After a Mastectomy





You have a right to get certain care and benefits after a mastectomy, including:

  • Reconstruction and surgery to make the breasts symmetrical

  • Prostheses

  • Treatment for health complications that came from having a mastectomy, including lymphedema

You can read more details about these benefits and other covered health care services in your health plan materials.


 

Who We Share Your Information With





We don't share your private information with anyone unless it's both legal and necessary. But to help provide, process and pay for your health care, we may share your information with certain companies we do business with, like:

  • Financial institutions

  • Other insurance companies health plans and health care providers

  • Marketing partners

  • Certain other third parties as needed

You can read our full Notice of Privacy Practices at bcbst.com/NOPP.


 

Who Has Access to Your Information

The only BlueCross employees who can use and disclose your information are those who need it to do their job providing coverage for you. This includes claims processors, underwriters and customer service employees. We use physical, electronic and procedural protections to make sure no one else can access your information.


 

Where We Get Your Information

We receive information about your health care from:

  • Information you provide on applications or other forms
  • Information from your health records and transactions with us or other companies that we do business with

 

Are We Doing a Good Job With Your Coverage?

Making sure you get the care and service you deserve is important to us. We want you to be happy with us, so if there’s any reason you’re not, please tell us. We’ll do everything we can if you have a complaint about:

  • The quality of your care
  • Finding care
  • Your relationship with your providers or with us
  • Anything else related to your health plan

If you’re not happy with any part of your care or your plan, we want to hear from you. Just give us a call at 1-800-565-9140. If you’d rather write to us, please send it to us at:


BlueCross BlueShield of Tennessee
Commercial Member
Complaint Department
1 Cameron Hill Circle, Suite 0019
Chattanooga, TN 37402-0019

Quality Care

We want to help you live a healthier life, and our National Committee for Quality Assurance (NCQA) accredited Quality Improvement Program is one of the ways we do it. NCQA rates health insurance plans based on the care you receive and your feedback.

In 2024, BlueCross BlueShield of Tennessee and Blue Care Tennessee participated in an NCQA accreditation survey. Both the Commercial and Blue Care Tennessee lines of business achieved a perfect score of 100% on all NCQA requirements.

Our 4 STAR NCQA Accredited commercial quality improvement team is dedicated to promoting, educating, and encouraging preventive screenings and wellness checks to help you live a healthier life. Early detection through preventive screenings can result in better outcomes if any health issues are identified.

 

Promotion and Education

  • Awareness Campaigns:
    Informing you about the importance of preventive screenings and wellness checks.

  • Educational Materials:
     Providing resources such as brochures, webinars, and online content.

  • Yearly Digital Health Planner:
    A personalized health planner that provides a customized list of necessary screenings and checks.

 

Member Screening Events

  • Organized Events: Hosting in-person screening events across Tennessee for various health conditions.

  • In-Home Screenings and Home Kit Testing: Offering convenient options for those who prefer to have screenings done at home.

 

Proactive Health Management

  • Medication Adherence and Immunization Reminders: Our dedicated call team helps with medication adherence, refills, and immunization reminders.

By implementing these strategies, our commercial quality improvement team ensures you are well-informed, regularly screened, and proactive about your health, leading to improved overall well-being. Stay healthy and take advantage of these valuable resources!

For more information, contact us at: GM_Commercial_Quality_Improvement@bcbst.com


How Our Quality Care Program Works

Our goal is to work with you and your provider to improve your health and to help make sure you get the preventive screenings and tests you need. If our records indicate you may need a particular test, such as a diabetes eye exam, we may send you reminders throughout the year, including:


  • Health and Wellness

    • BlueCross provides you with resources to help improve and manage your health. To learn more about these resources, log in to bcbst.com/wellnesscenter or call 1-800-565-9140.

  • Decision Support Tools

    • With these resources, you can get help with handling health issues, formulating questions to ask your doctor, understanding symptoms, and exploring health topics and wellness tips that matter to you most. We also offer a shopping and decision support program, and you can obtain information about the average amount paid to network providers and estimates of your out-of-pocket costs for certain items and services by using our Healthcare Cost Estimator. You can use our Healthcare Cost Estimator by logging in to bcbst.com and clicking Find Care & Estimate Costs, or by logging in to BCBSTN and choosing Get Care.

  • Incentive Programs

    • We may offer voluntary wellness or health improvement programs that let you earn rewards or incentives. Those rewards or incentives may include cash or cash equivalents, merchandise, gift cards, debit cards, premium discounts or rebates, contributions toward your health savings account (if applicable), or modifications to a copayment, coinsurance, or deductible amount.

  • We'll let you know if you have the chance to participate in one of these programs or have the opportunity to earn incentives for choosing cost-effective providers.
If you have questions, please call us at 1-800-205-4983. or visit bcbstnews.com/quality. We add updates throughout the year, so check back from time to time.

BlueCross BlueShield of Tennessee 1 Cameron Hill Circle | Chattanooga, TN 37420 | bcbst.com

 

BlueCross BlueShield of Tennessee (BlueCross) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex1. BlueCross does not exclude people or treat them less favorably because of race, color, national origin, age, disability or sex.

BlueCross:

  • Provides people with disabilities reasonable modifications and free appropriate auxiliary aids and services to communicate effectively with us, such as: (1) qualified sign language interpreters and (2) written information in other formats, such as large print, audio and accessible electronic formats.
  • Provides free language assistance services to people whose primary language is not English, such as: (1) qualified interpreters and (2) information written in other languages.

If you need these reasonable modifications, appropriate auxiliary aids and services, or language assistance services, contact a consumer advisor at the number on the back of your Member ID card or call 1-800-565-9140. (TTY: 1-800-848-0298. or 711).

If you believe that BlueCross has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance (“Nondiscrimination Grievance”). For help with preparing and submitting your Nondiscrimination Grievance, contact a consumer advisor at the number on the back of your Member ID card or call 1-800-565-9140. (TTY: 1-800-848-0298 or 711). They can provide you with the appropriate form to use in submitting a Nondiscrimination Grievance. You can file a Nondiscrimination Grievance in person or by mail, fax or email. Address your Nondiscrimination Grievance to: Nondiscrimination Grievance; c/o Manager, Operations, Member Benefits Administration; 1 Cameron Hill Circle, Suite 0019, Chattanooga, TN 37402-0019; (423) 591-9208 (fax); Nondiscrimination_OfficeGM@bcbst.com (email).

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1–800–368–1019, 800–537–7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

You can contact BlueCross’s Nondiscrimination Coordinator at 423-535-1010 (TTY: 1-800-848-0298 or 711); Nondiscrimination_CoordinatorGM@bcbst.com (email); or Corporate Compliance, 1 Cameron Hill Circle, 1.4, Chattanooga, TN 37402.

This notice is available at BlueCross’s website: bcbst.com

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

BlueCross BlueShield of Tennessee is a Qualified Health Plan Issuer in the Health Insurance Marketplace.

1Consistent with the scope of sex discrimination described at 45 CFR 92.101(a)(2))

Language Assistance

ATTENTION: If you speak English, free language assistance services and appropriate auxiliary aids and services are available to you. Please call the Member Service number on the back of your Member ID card or 1-800-565-9140. (TTY: 1-800-848-0298.).

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma, así como ayudas y servicios auxiliares adecuados. Llame al número de Servicio de atención a miembros que figura en el reverso de su tarjeta de identificación de miembro o al 1-800-565-9140. (TTY: 1-800-848-0298.).

انتباه: إذا كنت تتحدث العربية، فتتوفر لك خدمات المساعدة اللغوية المجانية والخدمات والأدوات المساعدة المناسبة. يرجى الاتصال برقم خدمة الأعضاء الموجود على ظهر بطاقة هوية العضو الخاص بك أو بالرقم 1-800-565-9140. (الهاتف النصي: 1-800-848-0298.).

注意：如果您說中文，我們提供免費的語言協助服務，以及適當的輔助協助和服務。請撥打會員 ID 卡背面的會員服務部號碼或 1-800-565-9140.（聽障專線 (TTY)：1-800-848-0298.）。

LƯU : Nếu qu vị nói tiếng Việt, qu vị sẽ được cung cấp các dịch vụ hỗ trợ ngôn ngữ miễn phí và các dịch vụ và công cụ hỗ trợ phù hợp. Vui lòng gọi đến số của bộ phận Dịch vụ Hội viên ở mặt sau Thẻ ID Thành viên của qu vị hoặc số 1-800-565-9140. (TTY: 1-800-848-0298.).

주의: [한국어]를 사용하시는 경우, 무료 언어 지원 서비스 및 적절한 보조 기구와 서비스가 제공됩니다. 가입자 ID 카드 뒷면의 가입자 서비스 전화번호 또는 1-800-565-9140.(TTY: 1-800-848-0298.)번으로 전화하시기 바랍니다.

ATTENTION : Si vous parlez français, des services gratuits d’assistance linguistique et des aides et services auxiliaires appropriés sont à votre disposition. Veuillez appeler le numéro du Service adhérents indiqué au dos de votre carte d’assuré adhérent ou le 1-800-565-9140. (TTY/ATS : 1-800-848-0298.).

ເອົົ າໃຈໃສ່່: ຖ້້ າທ່່ານເວົ້ົ າພາສ່າ ພາສ່າລາວົ້, ມີີ ການບໍໍ ລິ ການຊ່່ວົ້ຍເຫຼືື ອົ ດ້້ ານພາສ່າ ແລະ ການຊ່່ວົ້ຍເຫຼືື ອົ ແລະ ການບໍໍ ລິ ການທ່ີ ເໝາະສ່ົ ມີໃຫຼື້ ທ່່ານ. ກະລຸນາ ໂທ່ ຫຼືາ ເບໍີ ຂອົງ ຝ່່ າຍ ບໍໍ ລິ ການສ່ະມີາຊ່ິ ກທ່ີ ມີີ ຢູ່່່ ດ້້ ານຫຼືື ງບໍ ດ້ ID ສ່ະມີາຊ່ິ ກ ຂອົງ ທ່່ານ ຫຼືື 1-800-565-9140. (TTY: 1-800-848-0298.).

ማስገንዘቢያ፦ አማርኛ የሚናገሩ ከሆነ፣ ነጻ የቋንቋ እርዳታ አገልግሎቶች እና ተገቢ ረዳት መርጃዎች እና አገልግሎቶች ለእርስዎ ይገኛሉ። በአባልነት መታወቂያዎ ጀርባ ላይ በሚገኘው የአባላት አገልግሎት ቁጥር ወይም በ 1-800-565-9140. (TTY: 1-800-848-0298.) ይደውሉ።

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlose Sprachassistenzdienste und geeignete Hilfsmittel und Dienstleistungen zur Verfügung. Bitte rufen Sie die Nummer des Mitgliederdienstes auf der Rückseite Ihrer Mitglieds-ID-Karte oder 1-800-565-9140. (TTY: 1-800-848-0298.) an.

ધ્યાાન આપોો: જોો તમેે ગુુજોરાાતી બોોલોો છોો, તો તમેારાા મેાટેે નન:શુુલ્ક ભાાષાા સહાાયા સેવાાઓ અને યાોગ્યા સહાાયાક સાધનો અને સેવાાઓ ઉપોલોબ્ધ છોે. કૃપોા કરાીને તમેારાા સભ્યા ID કાર્ડડની પોાછોળના સભ્યા સવાીસ નંબોરા ઉપોરા અથવાા 1-800-565-9140. (TTY: 1-800-848-0298.) પોરા કૉલો કરાો.

お知らせ：日本語をお話しになる場合は、無料の支援サービスと適切な補助器具・サービスがご利用いただけます。会員IDカードの裏面に記載の会員サービス番号あるいは1-800-565-9140. (TTY: 1-800-848-0298.)まで、お電話にてご連絡ください。

PANSININ: Kung kayo ay nagsasalita ng Tagalog, magagamit para sa inyo ang libreng mga serbisyong tulong sa wika at kaukulang mga karagdagang tulong at mga serbisyo. Mangyaring tawagan ang numero ng Serbisyo sa Miyembro na nasa likod ng inyong Kard ng ID ng Miyembro o sa 1-800-565-9140. (TTY: 1-800-848-0298.).

ध्यान दें: यदि आप हिंदी बोलते हैं, तो आपके लिए निःशुल्क भाषा सहायता सेवाएँ और उपलब्ध सहायता साधन और सेवाएं उपलब्ध हैं। कृपया अपने सदस्य ID कार्ड के पीछे दिए गए सदस्य सेवा नंबर या 1-800-565-9140 (TTY: 1-800-848-0298) पर कॉल करें।

ВНИМАНИЕ! Если Вы говорите по-русски, Вам будут предоставлены услуги языковой поддержки и соответствующие вспомогательные средства и сервисы на бесплатной основе. Позвоните в отдел обслуживания участников по номеру, указанному на обратной стороне Вашей идентификационной карты участника, или по номеру 1-800-565-9140. (TTY: 1-800-848-0298.).

توجه: اگر به زبان فارسی صحبت می کنید، خدمات کمک زبانی رایگان و مساعدت ها و خدمات کمکی مناسب در دسترس شما هستند. درصورتيکه عضو هستيد، با شماره خدمات اعضا در پشت کارت عضويت خود يا 1-800-848-0298. (TTY) 1-800-565-9140. تماس بگيريد

ATANSYON: Si w pale Kreyòl Ayisyen, genyen sèvis asistans gratis pou lang ansanm ak èd pou sèvis oksilyè apwopriye k ap disponib pou ou. Tanpri rele nimewo Sèvis Manm ki sou do kat ID Manm ou an oswa 1-800-565-9140. (TTY: 1-800-848-0298.).

UWAGA: Osoby posługujące się językiem polskim mogą bezpłatnie skorzystać z pomocy językowej oraz rozwiązań i usług pomocniczych. Prosimy zadzwonić pod numer działu obsługi ubezpieczonych podany na odwrocie karty identyfikacyjnej członka lub numer 1-800-565-9140. (TTY: 1-800-848-0298.).

ATENÇÃO: Se você fala Português, serviços gratuitos de assistência linguística e recursos e serviços auxiliares apropriados estão disponíveis para você. Ligue para o número de telefone do serviço de Atendimento ao Membro informado no verso de seu cartão de identificação de membro ou para 1-800-565-9140. (TTY: 1-800-848-0298.).

ATTENZIONE: se parla italiano, sono disponibili per Lei servizi gratuiti di assistenza linguistica nonché aiuti e servizi ausiliari adeguati. Chiami il numero del Servizio per i membri riportato sul retro della Sua scheda identificativa del membro oppure il numero 1-800-565-9140. (TTY: 1-800-848-0298.).

BAA’áKOHWIINIDZIN: Diné bizaad bee yáníłti’go, t’áá jiik’eh saad bee áka’aná’awo’ bee áka’anída’awoí dóó t’éadoole’é binahjíí bee adahodooníłígi diné bich’i’, andiabahts’ií bee bika’anída’awoí ná dahołó. T’áá shoodí Bił Ha’dít’éhii Bika’aná’awe Bił Ha’dít’éhii ID naaltsoos nitl’izí bine’dééj binámboo bee hodilníih doodago 1-800-565-9140. (TTY: 1-800-848-0298.).

WICHDICH: Wann du Deitsch schwetzscht un brauchscht Hilf fer communicat-e kenne mer dich helfe unni as es dich ennich eppes koschde zellt. Mir kenne differnti Sadde Schprooch-Hilf beigriege aa fer nix. Ruf der Member Service Number uff die hinnerscht Seit vun dei Member ID Card uff odder 1-800-565-9140. (TTY: 1-800-848-0298.).

FAASILASILAGA: Afai e te tautala i le faa-Samoa, o loo avanoa mo oe auaunaga fesoasoani mo gagana e aunoa ma se totogi faapea ma fesoasoani faʻaopoʻopo ma auaunaga talafeagai. Faamolemole valaʻau le numera o le Member Service (Auaunaga mo Tagata Auai( o loʻo i tua o lau pepa ID o le Member (Tagata Auai) po o le 1-800-565-9140. (TTY: 1-800-848-0298.).

GAKIULA: Gare iga go kapetal Faluwasch, ye toore paliuwal yamem bwe tepangug rel gamatefal lane kapetal Faluwasch. Fale peshem kol yegili nampal Member Service ila yelog liugul tagurul Member ID kard la yam gare 1-800-565-9140. (TTY: 1-800-848-0298.).

ATENSION: Guaha setbisio siha para hågu yanggen fifino’ CHamoru hao, dibåtde na setbision inayudon fumino’ CHamoru yan propriu na inasisten tråstes yan setbisio siha. Put fabot ågang i numiron Setbision Membro gi santatten i kattå-mu Member ID pat 1-800-565-9140. (TTY: 1-800-848-0298.).