Doctors and Hospitals

Selecting a Health Care Provider

With BlueAdvantage PFFS plans, you are free to seek care from any health care provider (d) that accepts Medicare payments and the terms, conditions and payment rates of our plan. There is no limited provider network. However, you must present your BlueAdvantage PFFS ID card before you receive services every time you visit a health care provider.

You may also use providers who do not accept the Medicare payment in full from Original Medicare. These providers may charge you more for Medicare-covered services, up to the Medicare Limiting Charge (d). You will be responsible for these excess charges (d). In any case, your BlueAdvantage PFFS ID card must always be presented before you receive services every time you visit a health care provider.

Provider Accepts BlueAdvantage PFFS 

If your provider decides to accept BlueAdvantage PFFS, he or she must bill BlueCross BlueShield of Tennessee for those services. As stated above, if your provider does not accept the Medicare payment in full from Original Medicare, you may be charged more for Medicare-covered services, up to the Medicare Limiting Charge. You will be responsible for these excess charges.

Providers have the right to decide if he or she will accept BlueAdvantage PFFS plans each time you are seen. This is why you must present your BlueAdvantage PFFS ID card every time you visit a health care provider.

Provider Does Not Accept BlueAdvantage PFFS

If providers do not accept your card because the plan is unfamiliar, please ask them to call our provider service line at 1-800-841-7434 for more information. A provider can decide at any time not to accept a BlueAdvantage PFFS plan. If this happens, you will need to select another provider.

For more information, please read:

• What People On Medicare Need to Know About Private Fee-For-Service Plans (PDF)