Blue Review - Blue Cross and Blue Shield of Oklahoma

 
 

Nov. 5, 2015

Important Information for BCBSOK Providers

Blue Cross and Blue Shield of Oklahoma (BCBSOK) recognizes that successful health care management includes the active participation of the member with their provider(s). As part of the communication plan, providers are informed about members’ rights and responsibilities within the health plan.

PPO and Marketplace Member Rights
You have the right to:

  • Confidentiality of health information
  • Receive Medically Necessary and appropriate care and service as defined in this Certificate
  • Receive courteous and respectful care and services from BCBSOK employees and network Providers
  • Receive information in clear and understandable terms
  • Participate with your Provider in decision−making about your health care treatment
  • Refuse treatment
  • File complaints when dissatisfied with the care and treatment received
  • Appeal an adverse Benefit determination or a decision regarding a Preauthorization request
  • Designate an authorized representative to act on your behalf in pursuing a Benefit claim or appeal of an adverse benefit determination

BlueLincs Member Rights and Responsibilities
You have the right to:

  • The right to receive information about BlueLincs, its services, its practitioners and Providers, and Members’ rights and responsibilities
  • The right to receive or have arranged by your BlueLincs Provider all Medically Necessary care covered under your benefit package           
  • The right to considerate and courteous care with respect for personal privacy
  • The right to be informed in clear, understandable language about your diagnosis, treatment options and prognosis
  • The right to be involved in decision-making concerning your treatment    
  • The right to candid discussion of appropriate or Medically Necessary treatment options for your conditions regardless of cost or benefit coverage
  • The right to confidentiality of information concerning your treatment
  • The right to know the identity of all persons involved in your care
  • The right to refuse treatment and to be told of the medical consequences
  • The right to be informed of research projects involving your care and the right to refuse participation in them
  • The right to file a complaint, grievance or appeal and be given due process
  • The right to designate an authorized representative to act on your behalf in pursuing a benefit claim or appeal of an adverse benefit determination

You have the responsibility to:

  • The responsibility to work with your PCP in maintaining a satisfactory physician-patient relationship
  • The responsibility to contact your PCP for authorization of care when you choose to use your benefits
  • The responsibility to comply with the prescribed medical treatment
  • The responsibility to provide complete health status information for accurate diagnosis and appropriate treatment
  • The responsibility to keep appointments for care and give required cancellation notice
  • The responsibility to read and understand all materials concerning your health benefits
  • The responsibility to notify your Employer and BlueLincs of any other Group coverage you have, and cooperate with BlueLincs in its coordination of benefits efforts
  • The responsibility to pay any required portion of your premium, as well as Copayment,
  • Coinsurance and/or Deductible amounts required under your benefits coverage
  • The responsibility to call BlueLincs whenever you are unsure of procedures or covered benefits.
  • Contact them at the number on the back of your ID card

 

 


 Blue Cross and Blue Shield of Oklahoma is a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.