Blue Care Network of Michigan

What is an HMO?

A Health Maintenance Organization, or HMO, is a health plan that provides a full range of health care services, including preventive services. HMO members select a primary care physician, or PCP, from the health plan's participating providers; and the PCP provides or coordinates most care.

Who do I call if I have a question about a claim?

For questions regarding claims, contact BCN Advantage Customer Service. Have your bill ready so you can provide the date of service, the bill amount, and the provider name and phone number.

Why can't I use my Medicare card?

BCN Advantage is a health care plan for people with Medicare. Now that you are a member of BCN Advantage, you have a BCN Advantage membership card. You are still in Medicare and have Medicare rights and protections; however, you must use your BCN Advantage plan membership card to get covered services.

What is my contract ID or deidentified number?

The contract ID or deidentifed number is the unique identifying number assigned to you by BCN. It is a nine-digit number with a prefix of XYK that can be found on your membership card.

How do I check to see if my doctor is in the BCN Advantage network?

Look in your provider directory or, for the most updated information, visit our Web site at MiBCN.com or call Customer Service.

What if the doctor I am seeing is not a BCN Advantage network provider?

Care or services you receive from doctors outside the BCN Advantage provider network are not covered by BCN Advantage or Original Medicare. The only exception is emergency or urgently needed care.

How do I get care when I'm out of the BCN Advantage service area?

To find a participating Blues provider when you travel outside the BCN Advantage service area, call the number on the back of your membership card. You should also call your PCP, so he or she can coordinate your follow-up care when you return home.

Am I covered for emergency services?

Yes. You are always covered for urgent and emergency care no matter where you travel or who provides the care. For service outside the United States, you may have to pay the bill and request reimbursement from BCN Advantage.

Do I need a referral to get care from a specialist?

Your PCP will provide most of your care and, when needed, refer you to a specialist who will provide care for the duration of the referral. Individual referrals are not needed for each visit to the specialist. In most instances, you need to coordinate your care through your PCP; however, there are limited circumstances in which you do not:

In the event of an emergency – call 911 or go directly to an emergency room.

For mental health or substance abuse treatment – call the BCN Advantage behavioral health unit at 1-800-431-1059. TTY users should call 1-800-430-3211.

Routine gynecological services – women may see any participating physician or OB/GYN.

Will more doctors be added to the network?

Yes. For the most current information about our growing network, visit our Web site at MiBCN.com/medicare or call Customer Service.

Where can I go for my hearing and dental care?

BCN Advantage hearing and dental care are provided through contracted network providers. To find a provider near you, call Customer Service.

Who should I call if I need mental health or substance abuse services?

You can access behavioral health coverage without a referral from your PCP by calling 1-800-431-1059. TTY users should call 1-800-430-3211.

Is my contract based on a calendar year or a running year?

Individual BCN Advantage contracts are based on a calendar year (Jan. 1 through Dec. 31)

How do I have premiums automatically deducted from my bank account or Social Security check?

If you would like your premium to be deducted directly from your checking or savings account, you can request an Authorization Agreement for Automatic Payments form from our Customer Service department.

If you would like your premium deducted from your Social Security check and you did not request it on your BCN Advantage enrollment form, you can call Customer Service and request the deduction. It may take up to 90 days for your Social Security check to reflect deductions; during this time you are responsible for paying your premium.

Why do the premiums vary from county to county?

Medicare pays BCN Advantage to provide health care services to Medicare beneficiaries in 31 Michigan counties. This payment is determined, in part, by how much it costs the federal government to insure beneficiaries in a given county. Because the health of each county's beneficiaries is unique, the payment varies and so do our premiums.

I've made payments for services covered by BCN Advantage that were billed to me. How do I get reimbursed?

Call Customer Service to request a BCN Advantage reimbursement form or mail your original receipts with a written request for reimbursement (include your name and contract ID number) to:

Blue Care Network
P.O. Box 68753
Grand Rapids, MI 49516-8753

Remember to save a copy of the original receipt and your written request for your files.

How do I know if I have a low-income subsidy or if I am eligible for a low-income subsidy?

The Social Security Administration sends a letter to those who are eligible for a low-income subsidy, which is assistance in paying for Part D drugs. If you feel you are eligible and have not received a letter from the SSA, you may call them at 1-800-772-1213 or visit their Web site at socialsecurity.gov. TTY users may call 1-800-325-0778.

If my low-income subsidy is 100 percent, why am I still getting billed for a portion of my Part D premium?

Individual members may be billed a portion of the Part D premium due to built-in enhanced benefits that include lower fixed copayments and/or coverage of generic drugs in the coverage gap. These enhanced benefits are not covered by the low-income subsidy.

What is a copayment?

A copayment is a fixed dollar amount that you must pay your doctor or other health care professional for a covered service.

What is a coinsurance?

A coinsurance is a percentage of the Medicare-approved amount that you must pay your doctor or other health care professional for a covered service. For example, you pay 20 percent of the cost of your durable medical equipment charge.

Important information about this plan

BCN Advantage HMO is available in these counties: Allegan, Barry, Bay, Calhoun, Clinton, Eaton, Genesee, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Kent, Lapeer, Livingston, Macomb, Midland, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Saginaw, Shiawassee, St. Clair, Tuscola, Van Buren, Washtenaw and Wayne. Premiums vary by county. You must continue to pay your Medicare Part B premium.

You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor BCN Advantage HMO will be responsible for the costs. Out-of-network services authorized by BCN Advantage HMO will be covered.

If you are enrolled in BCN Advantage HMO Option 2 or Option 3, you must use a network pharmacy to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Our pharmacy network includes the majority of chain pharmacies, mail order through Medco or Walgreens, as well as long-term care and home infusion pharmacies. For additional information on network pharmacies, please call Customer Service at 800-450-3680, 8 a.m. to 8 p.m., seven days a week. TTY users should call 800-430-3211. You may also write to: BCN Advantage HMO, 2311 Green Road, Ann Arbor, MI 48105.

The BCN Advantage HMO benefit information provided is not comprehensive. Additional information should be requested before making a decision about your coverage. For full information on BCN Advantage HMO benefits, current members should call our Customer Service department at 800-450-3680, from 8 a.m. to 8 p.m., seven days a week. TTY users should call 800-430-3211. Prospective members should call 877-469-2583, from 8 a.m. to 8 p.m., seven days a week. TTY users should call 800-481-8704.

Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1, 2011. Please contact BCN Advantage HMO for details.

If you decide to have your BCN Advantage HMO premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

BCN Advantage HMO is issued by Blue Care Network, which contracts with the federal government. BCN Advantage HMO’s contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.