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.
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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
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.
BlueCross BlueShield of Tennessee
Medicare Advantage Appeals & Grievances Department
1 Cameron Hill Circle, Suite 0005
Chattanooga, TN 37402
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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:
Making a request in writing to us. If you need more information on how to do this, call 1-800-831-25831-800-831-2583 (TTY: 711711).
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.
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We’re here to help
Whether you have questions about health insurance or you want to learn about your plan details, our Member Care Team is here for you.If you have any questions about your plan details, our Member Care Team is here for you online, or call 1-888-770-8840 (TTY: 711)1-888-770-8840 (TTY:711), 7 days a week from 8 a.m. – 9 p.m. ET.