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We will tell you what you can do if you think you are being treated unfairly or your rights are not being respected. If you want Medicare publications about your rights, you may call and request them at 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. You can call 24 hours a day, 7 days a week.
Your right to be treated with fairness and respect
You have the right to be treated with dignity, respect, and fairness at all times. We must obey laws against discrimination that protect you from unfair treatment. These laws say that we cannot discriminate against you (treat you unfairly) because of your race or color, age, religion, national origin, or any mental or physical disability you may have.
If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, please let us know. You can also reach the Office for Civil Rights at 800-368-1019 (TTY 800-537-7697), or you can contact the regional Office for Civil Rights in your area.
Southern Regional Office for Civil Rights
States in the Southern region:
- North Carolina
- Alabama
- Florida
- Georgia
- Kentucky
- Mississippi
- South Carolina
- Tennessee
Contact Information:
Phone number: 800-368-1019
TTY number: 800-537-7697 (For the hearing and speech impaired)
Address:
Office for Civil Rights
US Department of Health and Human Services
Atlanta Federal Center
Suite 16T70
61 Forsyth Street, SW
Atlanta, GA 30303
ATTENTION: if you require language assistance services, these are available to you free of charge. Please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.
Your right to the privacy of your medical records and personal health information
There are federal and state laws that protect the privacy of your medical records and personal health information. We keep your personal health information private as protected under these laws. Any personal health information (PHI) that you give us when you enroll in this plan is protected.
We will make sure that unauthorized people do not see or change your records. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who is not providing your care or paying for your care.
There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used.
We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. For example, you have the right to look at your medical records, and to get a copy of the records (there may be a fee charged for making copies).
You also have the right to ask us to make additions or corrections to your medical records (if you ask us to do this, we will review your request and determine whether the changes are appropriate).
You have the right to know how your health information has been given out and used for non-routine purposes. If you have questions or concerns about the privacy of your personal information and medical records, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.
Your right to get your prescriptions filled within a reasonable period of time
You should get all of your prescriptions filled from an in-network pharmacy, that is, from pharmacies that contract with Blue Cross NC.
You have the right to go to any network pharmacy in order to get your prescriptions filled at the benefit level.
You have the right to timely access to your prescriptions. "Timely access" means that you can get your prescriptions filled within a reasonable amount of time.
Your right to know your treatment choices and participate in decisions about your health care
You have the right to know about the different Medication Management Treatment Programs we offer and in which you may participate. You have the right to be told about any risks involved in your care. You have the right to refuse treatment. This includes the right to stop taking your medication. If you refuse treatment, you accept responsibility for what happens as a result of refusing treatment.
You have the right to get a detailed explanation from us if you believe that a network pharmacy has denied coverage for a drug that you believe you are entitled to get or care you believe you should continue to get.
Your right to make complaints
You have the right to make a complaint if you have concerns or problems related to your coverage or care. "Appeals" and "grievances" are the 2 different types of complaints you can make. Which one you make depends on your situation. You can make a complaint on the Medicare complaint form.
If you make a complaint, we must treat you fairly (i.e., not discriminate against you). You have the right to get a summary of information about the appeals and grievances that members have filed against us in the past. To get this information, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.
Your right to get information about your drug coverage and costs
This website tells you what you have to pay for prescription drugs as a member of Blue Cross NC. If you need more information, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.
You have the right to an explanation from us about any bills you may get for drugs not covered by your plan. We must tell you in writing why we will not pay for a drug, and how you can file an appeal to ask us to change this decision.
Your right to get information about our plan and our network pharmacies
You have the right to get information from us about Blue Cross NC and our plans. This includes information about our financial condition and about our network pharmacies. To get any of this information, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.
Your right to disenroll from your plan
You have the right to disenroll from Blue Medicare Plans during certain periods by giving written notice to Blue Cross NC of your intent to do so. Coverage will end on the last day of the month following the date that Blue Cross NC receives your written request.
To end your coverage, you may send written notice to Blue Medicare Plans, PO Box 30010, Durham, NC 27702. You will receive an acknowledgement of your disenrollment from Blue Cross NC.
How to get more information about your rights
If you have questions or concerns about your rights and protections, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.
You can also get free help and information from Seniors' Health Insurance Information Program (SHIIP). You can reach SHIIP at 855-408-1212. In addition, the Medicare program has written a booklet called Your Medicare Rights and Protections. To get a free copy, call 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. You can call 24 hours a day, 7 days a week. Or, you can visit medicare.gov to order this booklet or print it directly from your computer.
What can you do if you think you have been treated unfairly or your rights are not being respected?
For concerns or problems related to your Medicare rights and protections described in this section, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card. You can also get help from SHIIP by calling 855-408-1212.
What are your responsibilities as a member of Blue Cross NC?
Along with the rights you have as a Blue Cross NC member, you also have some responsibilities. Your responsibilities include the following:
- Become familiar with your coverage and the rules you must follow to get care as a member. Use the information available on this website as well as other information we give you to learn about your coverage, what you have to pay, and the rules you need to follow. If you have questions, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.
- Give your health care provider(s) the information they need to care for you, and follow the treatment plans and instructions given to you. Be sure to ask your health care provider(s) if you have any questions.
- Pay your plan premiums and any copayments you may owe for the covered drugs and medical services you get.
- Let us know if you have any questions, concerns, problems, or suggestions. If you have questions, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.
Disclosures:
Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal.
Blue Cross and Blue Shield of North Carolina Senior Health DBA Blue Cross and Blue Shield of North Carolina is an HMO-POS D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal.
Blue Medicare Supplement plans offered: Plan A: BMS A, 1/24, Plan G: BMS G, 1/24, Plan HI DED G: BMS HDG, 1/24, Plan K: BMS K, 1/24, Plan N: BMS N, 1/24.
Blue Medicare Supplement is not endorsed by or affiliated with the United States Government or the federal Medicare program.
The federal government requires all Medicare Advantage members to continue paying their Part B premium each month.
Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, sexual orientation or source of payment. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
Links marked with an external site icon indicate that you're leaving BlueCrossNC.com and Blue Cross and Blue Shield of North Carolina's plan information. The site you're going to is either a third-party vendor contracted with Blue Cross NC to provide services or an external website independent of Blue Cross NC.
To view PDF documents, you need to download and install Adobe Acrobat Reader on your computer.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers several decision-support tools to aid you in making decisions around your health care experience. These tools are offered for your convenience and should be used only as reference tools. You should consult your own legal counsel, tax advisor or personal physician as applicable throughout your health care experience.
Out-of-network / non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
The Blue FlexCard is issued by Stride Bank, N.A., Member FDIC, pursuant to license by Mastercard International. Stride Bank is an independent company offering debit card services and is solely responsible for its products.
Blue Cross NC contracts with independent companies to provide supplemental benefits. Those companies are responsible for the services they provide. They do not provide Blue Cross or Blue Shield products or services. Marks and trade names are property of their respective owners.
Change Healthcare is an independent company providing revenue and payment cycle management on behalf of Blue Cross and Blue Shield of North Carolina.
FitOn Health is an independent company providing health and fitness services on behalf of Blue Cross and Blue Shield of North Carolina.
CareLinx is an independent company providing in-home care solutions on behalf of Blue Cross and Blue Shield of North Carolina.
TruHearing is an independent company providing hearing health and hearing aids on behalf of Blue Cross and Blue Shield of North Carolina.
Current as of 07/12/2024 | Y0079_12997_M CMS Accepted 11132024 | U36079, 6/24
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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