Rights and Responsibilities for PPO and Traditional Members

What is this about?

This information lets you know all the rights you have as a Blue Cross Blue Shield of Michigan member, including what you can expect from us and what you can do as a member.

Select a topic below to learn more:

Member rights
Member responsibilities

Member rights

As a Blue Cross Blue Shield of Michigan member, you have the right to:

  • Receive clearly written information about Blue Cross Blue Shield of Michigan, its service, doctors and other medical professionals and your rights and responsibilities
  • Receive information about your treatment that is easy to understand
  • Receive medically necessary care as outlined in the Member Handbook and Summary of Benefits and Coverage
  • Receive considerate and courteous care that respects your privacy and human dignity
  • Candidly discuss appropriate medically necessary treatment options for your health conditions, regardless of cost or benefit coverage
  • Participate with providers in decision making regarding your health care
  • Expect confidentiality regarding your care and that Blue Cross Blue Shield of Michigan will adhere to strict internal and external guidelines concerning your personal health information. This includes 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 your actions
  • Voice concerns or complaints about your health care by contacting the Customer Service department or submitting a formal, written grievance through the Blue Cross Blue Shield of Michigan appeals process
  • Review your medical records at your physician's office by scheduling an appointment during regular business hours
  • Make recommendations regarding our member rights and responsibilities policies
  • Request the following information from Blue Cross Blue Shield of Michigan: 
    • The current provider network in your region 
    • The professional credentials of the health care providers who participate with Blue Cross Blue Shield of Michigan, 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 doctors 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 Blue Cross Blue Shield of Michigan and a participating provider

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Member responsibilities

As a Blue Cross Blue Shield of Michigan member, you have the responsibility to:

  • Read all Blue Cross Blue Shield of Michigan materials provided for members, and call our Customer Service department with any questions
  • Coordinate all nonemergency care through your primary care doctor
  • Use the Blue Cross Blue Shield of Michigan provider network unless otherwise approved by Blue Cross and your primary care doctor
  • Comply with the plans and instructions for care that you agreed to with your providers
  • Provide, to the extent possible, complete and accurate information that Blue Cross Blue Shield of Michigan and its providers need in order to provide care
  • Make and keep appointments for nonemergency medical care. You must call your doctor's office to cancel an appointment
  • Participate in the medical decisions regarding your health
  • Be considerate and courteous to providers, their staff and other patients
  • Notify Blue Cross Blue Shield of Michigan of address changes and additions or deletions of dependents covered by your contract
  • Protect your identification card against misuse and contact Customer Service immediately if your card is lost or stolen
  • Report all other health care coverage or insurance programs that cover your health and your family's health
  • Participate in understanding your health problems and the development of mutually agreed upon treatment

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