MEDICARE MEMBER RIGHTS

We want you to know your rights and get the care you need

You can do a lot to make sure you’re getting what you need from us. Here are a few of your options and things you should know about when you’re working with us.

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Asking for more coverage

Don’t be afraid to ask us to cover something that you and your doctor feel you need. We take every request seriously and want you to get the care that’s right for you.

How do I ask for medical services?

You, your doctor or your representative can contact us about providing coverage for your medical care.

Call:
For BlueAdvantage (PPO)SM plans: 1-800-831-25831-800-831-2583 (TTY:711711)
For BlueEssential (HMO SNP)SM plans: 1-888-851-25831-888-851-2583 (TTY:711711)

Fax:
1-423-535-5243

Mail:
BlueCross BlueShield of Tennessee
Medicare Advantage Operations
1 Cameron Hill Circle, Suite 0005
Chattanooga, TN 37402

How do I ask for prescriptions?

You, your physician or your representative need to send a letter or complete a Request for Prescription Determination Form and contact us.

Mail:
BlueCross BlueShield of Tennessee
Medicare Part D Coverage Determinations and Appeals
1 Cameron Hill Circle, Suite 51
Chattanooga, TN 37402-0051

Fax:
1-423-591-9514

Call:
1-800-831-2583 1-800-831-2583 (TTY:711711)

Asking us to reconsider a decision

If we’ve made a decision you don’t agree with, you can ask us to reconsider (or “file an appeal”). We’ll look again at a service or prescription we’ve denied within 60 days of our original decision.

How do I file an appeal for medical services?

You or your representative will need to send a letter or complete the BlueAdvantage Appeals Form or the BlueEssential Appeals Form and contact us.

Mail:
BlueCross BlueShield of Tennessee
Medicare Advantage Appeals & Grievances Department
1 Cameron Hill Circle, Suite 0005
Chattanooga, TN 37402

Fax:
1-423-535-5270

Call:
For BlueAdvantage (PPO)SM plans: 1-800-831-25831-800-831-2583 (TTY:711711)
For BlueEssential (HMO SNP)SM plans: 1-888-851-25831-888-851-2583 (TTY:711711)

How do I file an appeal for prescriptions?

You, your physician or your representative need to send a letter or complete a Request for Prescription Redetermination Form and contact us.

Mail:
BlueCross BlueShield of Tennessee Medicare Part D Coverage Determinations and Appeals
1 Cameron Hill Circle, Suite 51
Chattanooga, TN 37402-0051

Fax:
1-423-591-9514

Call:
1-800-831-25831-800-831-2583 (TTY:711711)

How do I get extra help?

If your health care needs are urgent or you are getting ongoing care, you can start another appeal with an outside agency at the same time we’re reviewing your appeal.

  1. Social Security Administration (SSA)
    Call: 1-800-772-12131-800-772-1213(TTY:1-800-325-07781-800-325-0778)
    Visit SSA.gov

  2. Tennessee State Health Insurance Assistance Program (SHIP)
    Call: 1-877-801-00441-877-801-0044 (TTY: 1-800-848-02981-800-848-0298)
    Visit TN SHIP

  3. SHIP for another state
    Visit SHIP Technical Assistance Center

Making a complaint

If you aren’t satisfied with the quality of care you received through your plan, a network provider or pharmacy, you can file an official complaint.

How do I submit a complaint?

To contact us in writing, complete the BlueAdvantage Grievance Form or the BlueEssential Grievance Form and mail or fax it to us.

Mail:
BlueCross BlueShield of Tennessee
Medicare Advantage Appeals & Grievances Department
1 Cameron Hill Circle, Suite 0005
Chattanooga, TN 37402

Fax:
1-423-535-5270

Call:
For BlueAdvantage (PPO)SM plans: 1-800-831-25831-800-831-2583 (TTY:711711)
For BlueEssential (HMO SNP)SM plans: 1-888-851-25831-888-851-2583 (TTY:711711)

The Medicare Beneficiary Ombudsman is a person who reviews complaints (also called “grievances”) and helps resolve them. To contact the Medicare Beneficiary Ombudsman: call 1-800-MEDICARE or 1-800-633-42271-800-633-4227, TTY:1-877-486-20481-877-486-2048 for more information visit medicare.gov. Or you can fill out Medicare's complaint form to send feedback about issues with your Medicare plan.

Appointing a representative

If you need help filing an appeal, you can assign someone like a family member, friend, advocate, attorney or any doctor to represent you. They can:

  • Get information about your claim
  • Submit evidence
  • Make requests
  • Give or receive notices about the appeal

How do I appoint a representative?

Both you and your representative need to sign, date and fill out the Appointment of Representative form. Then, send in the signed form with your coverage decision request.

Mail:
BlueCross BlueShield of Tennessee
Medicare Advantage Appeals & Grievances Department
1 Cameron Hill Circle, Suite 0005
Chattanooga, TN 37402

Fax:
1-423-535-5270

Leaving your plan

We understand that changing coverage plans can be intimidating. That’s why we want to help you understand your responsibilities and ours when it comes to disenrollment.

When can you end your membership in our plan?

We always want you to have coverage that fits your needs. If you want to change your Medicare plan coverage, there are certain times when you can enroll for different coverage, depending on your plan.

Annual Election Period (AEP): October 15 – December 7
Most people who are eligible for Medicare enroll during the AEP. During this time, you can:

  • Enroll in a Medicare Advantage plan for the first time.
  • Change prescription drug plans.
  • Change Medicare Advantage plans.
  • Return to Original Medicare.

Medicare Advantage Open Enrollment Period (OEP): January 1 – March 31
During OEP, Medicare Advantage plan enrollees can disenroll from their Medicare Advantage plan and return to Original Medicare or make a one-time switch to a different Medicare Advantage plan.

Special Enrollment Period (SEP)
You can enroll in a different Medicare Advantage plan at any time if any of the following situations apply to you:

  • You have moved outside of the service area.
  • You have Medicaid.
  • You are eligible for Extra Help with paying for your Medicare prescriptions.
  • Your plan changes its contract with Medicare.
  • You are getting care in an institution, such as a nursing home or long-term care hospital.
  • You enroll in the Program of All-inclusive Care for the Elderly (PACE).

Can I be disenrolled from my program?

Your health is important to us, but we would have to end your membership in the plan if any of the following happens:

  • You don't stay continuously enrolled in Medicare Part A and Part B.
  • You move out of the service area for more than six months.
  • You become incarcerated.
  • You lie about or withhold information about other insurance you have that provides prescription drug coverage.
  • You intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility.
  • You continuously behave in a way that is disruptive and makes it difficult for us to provide medical coverage for you and other members of our plan.
  • You let someone else use your membership card to get medical care.
  • You do not pay your plan premium for 90 days.

What are my responsibilities?

Usually you would just enroll in another Medicare plan to end your membership in our plan. But if you want to switch from our plan to Original Medicare without a Medicare prescription drug plan, you need to ask to be disenrolled from our plan by either:

Between the time that your membership ends and you begin your new plan, you’ll need to get your medical care and prescription drugs through our plan.

If you disenroll from Medicare prescription drug coverage and go without prescription drug coverage that pays at least as much as Medicare’s standard prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later.

What are my plan’s responsibilities?

If we end your membership in our plan, we need to tell you our reason in writing. We also need to explain how you can make a complaint about our decision.