Annual notice: What you need to know about our programs

At Blue Cross Blue Shield of Michigan and Blue Care Network, we continually implement, monitor, measure and evaluate strategies to improve the quality of care delivered to our members. Here’s a recap of some recent achievements:

• We successfully maintained accreditation with a Commendable rating from the National Committee for Quality Assurance for both our PPO and HMO.
• Blue Care Network received an Excellent rating from NCQA for our Medicare product.
• We launched a member mobile application, providing members with quick and easy access to Blue Cross account information.
• As part of our pharmacy programs, we developed a Medication Adherence Toolkit to assist physician organizations with their adherence efforts. And we distributed an Antibiotic Overuse Toolkit to promote appropriate antibiotic use.
• Electronic medical record use increased from 2015 to 2016 — advancing the speed of information exchange and improving patient data accuracy.
• Sixty-eight Michigan hospitals have signed a value-based contract.
• A total of 1,638 practices have been designated as patient-centered medical homes.

We annually update information about the following:

• Members rights and responsibilities
• Clinical practice guidelines
• Criteria used for level of care utilization management decisions
• Comprehensive care management
• Medical policies
• Pharmacy management
• Statement about incentives
• Translation services
• Utilization management staff availability
• Behavioral health care

Note: If information is accessed differently for certain patient populations, instructions are provided for each. Otherwise, information is the same across product lines and patient populations.

Member rights and responsibilities
Blue Cross Blue Shield of Michigan and Blue Care Network members have the right to:

• Receive clear and understandable written information about Blue Cross and BCN, its services, practitioners and providers, and their member rights and responsibilities.
• Receive easy-to-understand information about their care.
• Receive medically necessary care as outlined in the New Member Handbook and Summary of Benefits and Coverage.
• Receive considerate and courteous care with respect to their privacy and human dignity.
• Candidly discuss medically necessary treatment options for their health conditions, regardless of cost or benefit coverage.
• Participate in decision-making regarding their health care.
• Expect confidentiality regarding their care and know that Blue Cross Blue Shield of Michigan adheres to strict internal and external guidelines concerning their 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 their actions.
• Voice concerns or complaints about their health care by contacting the Customer Service department or submitting a formal, written grievance through the Blue Cross and BCN appeals process.
• Review medical records at your office by scheduling an appointment during regular business hours.
• Make recommendations regarding the member rights and responsibilities policies of Blue Cross and BCN.
• Request the following information from Blue Cross and BCN:

• The current provider network in their region
• The professional credentials of the health care practitioners who are participating with Blue Cross and BCN, including participating practitioners 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 practitioner
• Any prior authorization requirement and limitation, restriction or exclusion by service, benefit or type of drug
• Information about the financial relationships between Blue Cross and BCN and a participating practitioner

Blue Cross and BCN members have the responsibility to:

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

Behavioral health care

For more information

• Information about our programs and additional resources are available at bcbsm.com/importantinfo.
• To request a printed copy of any of the information contained in this article, contact Vicki Boyle, director of Quality and Population Health, at 313-448-6145.
• If you have any questions about the information in this article, contact your provider consultant.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.