Additional Information

What is this about?

These are notices that Blue Cross Blue Shield of Michigan makes available to PPO and traditional members and providers.

These notices describe our relationships with our members and providers.

Submitting a complaint

Blue Cross Blue Shield of Michigan and your primary care physician are interested in your satisfaction with the services you receive as a member. If you have a problem or concern about your care, we encourage you to discuss this with your primary care physician first. Often your primary care physician can correct the problem to your satisfaction. You are always welcome to call our Customer Service department with any questions or problems you may have.

At any point during the complaint process, you may submit any information or evidence concerning the complaint to assist Blue Cross Blue Shield in our investigation. You may file a complaint or appeal verbally or in writing. Complaints will not be accepted through email. There are no fees or costs associated with filing a complaint. All complaints can be submitted through the Customer Service department line or via mail to the address listed below.

Customer Service line: Use the phone number on the back of your Blue Cross Blue Shield of Michigan ID card.

Mailing address:

BCBSM Complaints — Mail Code 2004
Blue Cross Blue Shield of Michigan
600 E. Lafayette Blvd.
Detroit, MI 48226

Fax: 1-877-348-2210

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Keeping your health information secure

At Blue Cross Blue Shield of Michigan, we've always followed strict internal procedures to protect the confidentiality of your health information. We value your membership, and we take our responsibility to protect the privacy and security of your health information very seriously.

Our Notice of Privacy Practices outlines how we will use and disclose your data while it's in our care. We're permitted to use and disclose your protected health information only as specified in our notice.

You may also call the Customer Service number on the back of your enrollee ID card to request a copy of the notice.

Some employer groups must provide their own notices. You should check with your employer to determine how you can get a copy of the notice.

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Determining coverage of care

Utilization management decision-making is based only on appropriateness of care and service and existence of coverage.

Blue Cross Blue Shield of Michigan does not specifically reward practitioners or other individuals for issuing denials of coverage.

Financial incentives for utilization management decision-makers do not encourage decisions that result in underutilization.

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Approving covered services

Blue Cross Blue Shield of Michigan needs to review and approve these health care services before you receive them:

  • Some radiology services, including CT, CTA, MRI, MRA, MRS, QCT bone densitometry, nuclear cardiology, PET, PET and PET/CT fusion, diagnostic CT colonography and CT abdomen and pelvis scans
  • Inpatient acute care
  • Skilled nursing care
  • Human organ transplant services
  • Inpatient mental health care
  • Inpatient substance abuse treatment
  • Rehabilitation therapy
  • Applied behavioral analysis

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Evaluating medical technology

The Medical Policy Administration of Blue Cross Blue Shield of Michigan and the Care Management department of Blue Care Network of Michigan are responsible for the evaluation of new technologies and the new applications of existing technologies, the development of medical policies related to these technologies and the development of coverage recommendations. This process includes, but is not limited to, the following areas for potential new technologies: medical procedures and services, medical devices, surgical procedures, behavioral health procedures and pharmaceuticals.

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Guaranteeing quality management

Blue Cross Blue Shield of Michigan conducts quality initiatives to improve health care for our members.

Download a description of our PPO quality program (PDF).

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Getting translation help

If you need translation help, call the Customer Service number on the back of your ID card.

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BlueCard®

The Bluecard program allows our members and their dependents to receive covered inpatient hospital care and physician services when traveling outside of the area of their plan’s coverage. Read the official disclosure statement of the BlueCard program for the Blue Cross Blue Shield of Michigan PPO plan (PDF) or the Blue Care Network HMO plan (PDF).

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Questions?

If you have any questions about our online privacy practices, call 313-225-9000.

©1996-2014 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.

State and Federal Privacy laws prohibit unauthorized access to Member's private information. Individuals attempting unauthorized access will be prosecuted.

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