Rights and Responsibilities for HMO Members

This information lets you know all the rights you have as a Blue Care Network member, including what you can expect from us and what you can do as a member.

Member rights

As a member, there are certain things you can expect from us. We refer to these as your rights. All members have the right to:

  • Receive information about their care in a manner that is understandable to them.
  • Receive medically necessary care as outlined in the member handbook.
  • Receive considerate and courteous care with respect for their privacy and human dignity.
  • Candidly discuss appropriate medically necessary treatment options for their health conditions, regardless of cost or benefit coverage.
  • Participate with practitioners in decision making regarding their health care.
  • Expect confidentiality regarding their care and that Blue Care Network will adhere to strict internal and external guidelines concerning the members’ personal health information including 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 customer service or submitting a formal, written grievance.
  • Receive clear and understandable written information about BCN, its services, its practitioners and providers and their rights and responsibilities.
  • Review their medical records at their physician’s office by scheduling an appointment during regular business hours.
  • Make recommendations regarding BCN’s members’ rights and responsibilities policies.
  • Request the following information from BCN: 
    • The current provider network in your region.
    • The professional credentials of the health care providers who participate with BCBSM, 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 physicians 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 BCN and a participating provider.
    • You, or an individual or entity designated by you, have the right to request a Certificate of Creditable Coverage at any time while you are a member, and up to 24 months after your BCN coverage ends. Simply call the customer service number on the back of your member ID card or 1-800-450-3680. TTY users dial 1-800-430-3211. You can also send a written request to:

                    Blue Care Network
                    PO Box 5184
                    Southfield, MI 48086

BCN members also have additional rights that relate to their personal health information and its protection. These rights are specified in BCN’s Notice of Privacy Practices. 

You also have rights if you participate in one of our disease management programs. Please refer to Rights and Responsibilities of Members in Living with Illness Programs for a complete listing of these rights. 

 

Member responsibilities

As a Blue Care Network member, there are certain things we expect from you. We refer to these as your responsibilities. All members have the responsibility to:

  • Read BCN General Provisions and Benefits booklet and the applicable riders, the Member Handbook and all other materials for members, and call BCN customer service with any questions.
  • Coordinate all nonemergency care through their primary care physician*.
  • Use the BCN provider network unless otherwise referred and approved by BCN and their primary care physician*.
  • Comply with the plans and instructions for care that they have agreed to with their practitioners.
  • Provide, to the extent possible, complete and accurate information that BCN and our practitioners and providers need in order to provide care for them.
  • Make and keep appointments for nonemergent medical care. They must call their doctor’s office if they need to cancel an appointment.
  • Participate in the medical decisions regarding their health.
  • Be considerate and courteous to practitioners, providers, their staff, other patients and BCN staff.
  • Notify BCN of address changes and additions or deletions of dependents covered by their contract.
  • Protect their identification card against misuse and contact customer service immediately if a card is lost or stolen.
  • Report to BCN all other health care coverage or health insurance programs that cover their health and their families’ health.
  • Participate in understanding their health problems and developing mutually agreed-upon treatment goals.


BCN members also have responsibilities if they participate in one of our disease management programs. Please refer to Rights and Responsibilities of Members in Living with Illness Programs for a complete listing of these responsibilities.

* Blue Elect Self-Referral members can self refer to Michigan doctors

Questions?

Privacy issues: To report a concern or if you think your protected health information has been compromised, please call us at 1-800-552-8278 or email us. Don't include any protected health information in your email. 

Other issues: For customer service, call the number on the back of your member ID card.