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PAP605

Member Responsibilities


Provider Administrative Policy

Section
Commercial Managed Care
Policy Date
July 2007
Status/Date
Reviewed/May 2008
Provider Type(s)
All Providers  

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

Member Responsibilities

As commercial managed care members, your patients have the responsibility to:

  • Provide physicians, or other health care providers, the information needed in order to care for them.
  • Treat all plan providers and personnel courteously and behave in a manner that supports the care provided to other patients and the general functioning of the facility.
  • Communicate openly with their provider,and develop patient/provider relationships based on mutual trust and cooperation.
  • Help to improve their own health condition by following treatment plans, instructions and care they have agreed on with their physician(s).
  • Accept the financial responsibility for any copayments, deductibles or coinsurance amounts associated with covered services received while under the care of a physician or while an inpatient at a facility.
  • Schedule appointments for medical care in a timely manner and keep scheduled appointments or give adequate notice of cancellation.
  • Use plan providers when applicable and present a member identification card when accessing medical services.
  • Obtain referrals when appropriate.
  • Review information regarding covered services, policies and procedures as stated in their Member Handbook or Member Certificate.
  • Ask questions of their primary care physician (PCP) or of Blue Cross of Idaho. If they have a suggestion, concern, or a payment issue, we recommend they call Customer Service number located on the back of the member identification card.
  • Call Customer Service when requesting a change of their PCP.

Policy History

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