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Timely and Quality Care


Provider Administrative Policy

Section
Member Rights and Responsibilities
Policy Date
July 2007
Status/Date
Reviewed/May 2008

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Timely and Quality Care

As a Medicare Advantage member, your patient has the right to:

  • A choice of a qualified contracting primary care physician (PCP), as applicable.
  • Self-referral to a contracting woman’s health specialist for women’s health care issues.
  • Self-referral to a contracting provider for mammography screening and influenza vaccinations.
  • A discussion of appropriate or medically necessary treatment options for the member’s condition, regardless of cost or benefit coverage.
  • Timely access to the member’s PCP and referrals to specialists when medically necessary.
  • Access to emergency services without prior authorization when the member, as a prudent layperson, acted reasonably, believing that an emergency medical condition existed. Payment will not be withheld in cases where the member sought emergency services.
  • Actively participate in decisions about their own health and treatment options.

Policy History

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