Medicare Member Rights

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Asking for more coverage

Don’t be afraid to ask us to cover something that you and your doctor feel you need. We take every request seriously and want you to get the care that’s right for you.

How do I ask for medical services?
How do I ask for prescriptions?
You, your prescriber or your representative need to send a letter or complete a Request for Prescription Determination Form (Updated: 1/1/2020) and contact us.
Mail:
BlueCross BlueShield of Tennessee
Medicare Part D Coverage Determinations and Appeals
1 Cameron Hill Circle, Suite 51
Chattanooga, TN 37402-0051
Fax:
1-423-591-9514
Call:
For BlueAdvantage (PPO)^SM plans: 1-800-831-2583, TTY 711
Monday through Friday from 8 a.m. to 9 p.m. ET

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Asking us to reconsider a decision

If we’ve made a decision you don’t agree with, you can ask us to reconsider (or “file an appeal”). We’ll look again at a service or prescription we’ve denied if you ask us within 65 days of our original decision.

How do I file an appeal for medical services?
How do I file an appeal for prescriptions?
You, your prescriber or your representative need to send a letter or complete a Request for Prescription Redetermination Form (Updated: 7/1/2020) and contact us.
Mail:
BlueCross BlueShield of Tennessee
Medicare Part D Coverage Determinations and Appeals
1 Cameron Hill Circle, Suite 51
Chattanooga, TN 37402-0051
Fax:
1-423-591-9514
Call:
For BlueAdvantage (PPO)^SM plans: 1-800-831-2583, TTY 711
Monday through Friday from 8 a.m. to 9 p.m. ET
How do I get extra help?
If your health care needs are urgent or you are getting ongoing care, you can start another appeal with an outside agency at the same time we’re reviewing your appeal.
Social Security Administration (SSA)
Call: 1-800-772-1213, TTY 1-800-325-0778
Visit SSA.gov

Tennessee State Health Insurance Assistance Program (SHIP)
Call: 1-877-801-0044, TTY 1-800-848-0298
Visit TN SHIP

Georgia State Health Insurance Assistance Program (SHIP)
Call: 1-866-552-4464
Visit GA SHIP

SHIP for another state
Visit SHIP Technical Assistance Center

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Making a complaint

If you aren’t satisfied with the quality of care you received through your plan, a network provider or pharmacy, you can file an official complaint.

How do I submit a complaint?
To contact us in writing, complete the vantage BlueAdvantage Grievance Form and mail or fax it to us.
Mail:
BlueCross BlueShield of Tennessee
Medicare Advantage Appeals & Grievances Department
1 Cameron Hill Circle, Suite 0005
Chattanooga, TN 37402
Fax:
1-423-535-5270
Call:
For BlueAdvantage (PPO)^SM plans: 1-800-831-2583, TTY 711
Monday through Friday from 8 a.m. to 9 p.m. ET
The Medicare Beneficiary Ombudsman is a person who reviews complaints (also called “grievances”) and helps resolve them. To contact the Medicare Beneficiary Ombudsman: call 1-800-MEDICARE or 1-800-633-4227, TTY 1-877-486-2048 for more information visit medicare.gov. Or you can fill out Medicare's complaint form to send feedback about issues with your Medicare plan.

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Appointing a representative

If you need help filing an appeal, you can assign someone like a family member, friend, advocate, attorney or any doctor to represent you. They can:

Get information about your claim
Submit evidence
Make requests
Give or receive notices about the appeal

How do I appoint a representative?

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Leaving your plan

We understand that changing coverage plans can be intimidating. That’s why we want to help you understand your responsibilities and ours when it comes to disenrollment.

When can you end your membership in our plan?
We always want you to have coverage that fits your needs. If you want to change your Medicare plan coverage, there are certain times when you can enroll for different coverage, depending on your plan.
Annual Enrollment Period (AEP): October 15 – December 7
Most people who are eligible for Medicare enroll during the AEP. During this time, you can:
Enroll in a Medicare Advantage plan for the first time.
Change prescription drug plans.
Change Medicare Advantage plans.
Return to Original Medicare.

Medicare Advantage Open Enrollment Period (OEP): January 1 – March 31
During OEP, Medicare Advantage plan enrollees can disenroll from their Medicare Advantage plan and return to Original Medicare or make a one-time switch to a different Medicare Advantage plan.
Special Enrollment Period (SEP)
You can enroll in a different Medicare Advantage plan at any time if any of the following situations apply to you:
You have moved outside of the service area.
You become entitled to Medicaid coverage.
You become eligible for Extra Help with paying for your Medicare prescriptions.
Your plan changes its contract with Medicare.
You are getting care in an institution, such as a nursing home or long-term care hospital.
You enroll in the Program of All-inclusive Care for the Elderly (PACE).
Can I be disenrolled from my plan?
Your health is important to us, but we would have to end your membership in the plan if any of the following happens:
You don’t stay continuously enrolled in Medicare Part A and Part B.
You move out of the service area for more than six months.
You become incarcerated.
You lie about or withhold information about other insurance you have that provides prescription drug coverage.
You intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility.
You continuously behave in a way that is disruptive and makes it difficult for us to provide medical coverage for you and other members of our plan.
You let someone else use your membership card to get medical care.
You do not pay your plan premium for 90 days.
What are my responsibilities?
Usually you would just enroll in another Medicare plan to end your membership in our plan. But if you want to switch from our plan to Original Medicare without a Medicare prescription drug plan, you need to ask to be disenrolled from our plan by either:
Calling 1-800-633-4227, TTY 1-877-486-2048.
Making a request in writing to us. If you need more information on how to do this, call:
For BlueAdvantage (PPO)^SM plans: 1-800-831-2583, TTY 711
Monday through Friday from 8 a.m. to 9 p.m. ET
Between the time that your membership ends and you begin your new plan, you’ll need to get your medical care and prescription drugs through our plan.
If you disenroll from Medicare prescription drug coverage and go without prescription drug coverage that pays at least as much as Medicare’s standard prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later.
What are my plan’s responsibilities?

MEDICARE MEMBER RIGHTS

How do I ask for medical services?

How do I ask for prescriptions?

How do I file an appeal for medical services?

How do I file an appeal for prescriptions?

How do I get extra help?

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How do I submit a complaint?

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How do I appoint a representative?

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When can you end your membership in our plan?

Can I be disenrolled from my plan?

What are my responsibilities?

What are my plan’s responsibilities?

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How do I get extra help?

How do I submit a complaint?

How do I appoint a representative?

When can you end your membership in our plan?

Can I be disenrolled from my plan?

What are my responsibilities?

What are my plan’s responsibilities?

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