Our Pledge to You:
Blue Cross Blue Shield of Vermont is committed to customer driven excellence and creating a superior member experience. We will strive to provide highly personalized local service with each and every member interaction. Your opinion of how we execute this pledge is welcomed and valued. We are committed to learn from your feedback and we promise to use your feedback to make meaningful progress and innovative change which you will value.
Our members have the right to:
- Receive information from us and your providers. Information we supply will help you understand our organization, your rights and responsibilities as a member, the network of providers included in your plan, and the services and benefits available to you and how to use them. Information supplied by your providers will help you understand your condition and plans for care.
- Participate with practitioners in making decisions about your health care. In addition, you have the right to engage in candid discussion of appropriate or medically necessary treatment options, regardless of the cost or your benefits.
- Request out-of-network services through the prior authorization process if a practitioner with an appropriate specialty is not available within your network to treat a medical condition. We recommend that you coordinate the out-of-network requests through your primary care physician to help facilitate coordination of care.
- Let us know when you disagree. Your first step when you have a complaint or concern is to call our customer service department. (1-800-247-2583).
- Recommend changes to us, including to this Member Rights and Responsibilities statement. We want to hear from you if you disagree with a decision or are unhappy with the care or service you receive.
- Provide feedback on our programs, including our quality improvement and care management programs. You can share your ideas with us by calling our customer service department at 1-800-247-2583 or emailing QualityImprovement@bcbsvt.com.
- Access records that we use to make decisions about your health care benefits.Receive information about your health plan, its services, practitioners and providers and members' rights and responsibilities.
Our members have the responsibility to:
- Choose a primary care physician if your policy requires it.
- Present your ID card each time you receive services and protect your BCBSVT ID card from improper use.
- Keep your providers informed and to understand the risk of not giving information others might need to treat you most effectively. For providers to effectively treat you and manage your care, tell them and others involved in coordinating care about your medical history and current health, and participate in developing treatment goals to the degree possible.
- Treat your providers and us with respect.
- Keep scheduled appointments and notify your provider's office ahead of time if you are going to be late or miss an appointment.
- Follow plan rules and instructions for care. To receive care or services, you must identify yourself as a member to providers and follow the policies and procedures described in your subscriber certificate and other plan materials.
- Pay all applicable copayments, coinsurance and deductibles to your health care providers, as specified in your Outline of Coverage or Certificate of Coverage.
- Notify the Plan as soon as possible if there is a change in family size, address, and phone number or membership status when you purchase coverage directly from BCBSVT.
- Report such changes directly to the benefits administrator at the group in a timely fashion ( only applicable if you are insured through a group plan or employer).