BCBSVT Member Rights & Responsibilities
Our Pledge to You:
Here at Blue Cross and Blue Shield of Vermont, we’re committed to creating superior member experiences and we’ll provide highly personalized service for each and every one of our interactions. We value and welcome your opinion about how we execute this pledge. We’ll learn from your feedback and use it to make meaningful progress and innovative changes.
As a member, you have the right to:
- Respect and Privacy. We take measures to keep your health information private and protect your healthcare records (Please see “Notice of Privacy Practices for Protected Health Information”). You have the right to be treated with respect and dignity.
- Receive Information from us. We’ll supply you with information to help you understand our organization, your rights and responsibilities as a member, your network of providers, the benefits available to you and how to use your benefits and services. You also have the right to access records we’ve used to make decisions about your health care benefits, services, our practitioners and our providers.
- Receive Information from Your Providers. Your providers will supply you with information so that you can better understand your condition and plans for care.
- Participate in Your Healthcare. You have the right to engage in a candid discussion of appropriate or medically necessary treatment options, regardless of cost or benefit coverage. You have the right to participate with practitioners in making decisions about your care. If you choose to receive services outside of your provider network, we encourage you to learn about and understand your plan benefits. Non-participating, out-of-state providers can bill you for the balance between what we pay and what the provider billed.
- Disagree. We welcome your complaints or appeals about our organization and the care you receive. For more information about how to file a complaint or an appeal please call our customer service team at (800) 247-2583. Helpful information is also available on our website, www.bcbsvt.com and by reviewing your enrollment materials.
- Recommend Changes. You have the right to suggest changes regarding our member rights and responsibilities policy. You can also provide feedback on our programs, including our quality improvement and care management programs.
As a member, you have the responsibility to:
- Choose a Primary Care Provider (PCP). This only applies if your plan requires a PCP.
- Present your ID card each time you receive services and protect your ID card from improper use.
- Keep your providers informed and understand that your doctors need your up-to-date health information to treat you effectively. Talk to your providers about your medical history (which includes mental health and substance abuse) and your current health, and participate in developing treatment goals as much as possible.
- Follow plan rules and instructions for your care that you have agreed to with your provider. To receive care or services, you must identify yourself as a member to providers and follow the policies and procedures described in the subscriber certificate (or summary plan description) and other plan materials.
- Treat your Providers and us with respect. This includes keeping scheduled appointments and notifying a provider ahead of time if you are late or need to reschedule.
- Better understand your health problems. To the degree possible, we encourage you to participate with the plan’s care management team and your provider (as appropriate) to develop a treatment plan.
- Pay all applicable Deductibles, Co-insurance amounts and Co-payments to your health care providers as outlined on your Outline of Coverage.
- Notify us right away if there’s a change in your family size, address or phone number, primary care provider or any other change in your membership.
- If you have your healthcare benefits through an employer group, please report your membership changes directly to your benefits administrator.
Revised: Mar 2015