Member rights
As a member, there are certain things you can expect from us. We refer to these as your rights. All members have the right to:
- Receive information about their care in a manner that is understandable to them.
- Receive medically necessary care as outlined in the member handbook.
- Receive considerate and courteous care with respect for their privacy and human dignity.
- Candidly discuss appropriate medically necessary treatment options for their health conditions, regardless of cost or benefit coverage.
- Participate with practitioners in decision making regarding their health care.
- Expect confidentiality regarding their care and that BCN will adhere to strict internal and external guidelines concerning the members personal health information including the use, access and disclosure of that information or any other information that is of a confidential nature.
- Refuse treatment to the extent permitted by law and be informed of the consequences of their actions.
- Voice concerns or complaints about their health care by contacting the Customer Service Department or submitting a formal, written grievance through the BCN member grievance program.
- Receive clear and understandable written information about BCN, its services, its practitioners and providers and their rights and responsibilities.
- Review their medical records at their physicians office by scheduling an appointment during regular business hours.
- Make recommendations regarding BCN’s members’ rights and responsibilities policies.
- Request the following information from BCN:
- The current provider network for their service area.
- The professional credentials of the health care providers who are participating with BCN, including participating providers who are board certified in the specialty of pain medicine and the evaluation and treatment of pain.
- The names of participating hospitals where individual participating physicians have privileges for treatment.
- How to contact the appropriate Michigan agency to obtain information about complaints or disciplinary actions against a health care provider.
- Any prior authorization requirement and limitation, restriction or exclusion by service, benefit or type of drug.
- Information about the financial relationships between BCN and a participating provider.
- You, or an individual or entity designated by you, have the right to request a Certificate of Creditable Coverage at any time while you are a member, and up to 24 months after your BCN coverage ends. Simply call the customer service number on the back of your ID card or 800-450-3680. TTY users dial 800-430-3211. You can also send a written request to:
Blue Care Network
PO Box 5184
Southfield, MI 48086
BCN members also have additional rights that relate to their personal health information and its protection. These rights are specified in BCN’s Notice of Privacy Practices. You also have rights if you participate in one of our disease management programs. Please refer to Rights and responsibilities of Members in Living with Illness Programs for a complete listing of these rights.
page modified 11/20/2009