Selecting a Health Care Provider

With BlueAdvantage PFFS plans, you are free to seek care from any health care provider that accepts Medicare and the terms and conditions of payment. 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.

A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan’s terms and conditions on our website at: http://www.bcbst.com/providers/BenefitHighlights.shtml.

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. You will be responsible for these excess charges. Your BlueAdvantage PFFS ID card must always be presented before you receive services every time you visit a health care provider.

If Your Provider Accepts BlueAdvantage PFFS

If your provider accepts 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 they 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.

If Your Provider Does Not Accept BlueAdvantage PFFS

If your provider does not accept your card, 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