What are my rights as a member?

When it comes to your health plan, knowledge is power

As a Blue Cross and Blue Shield of Kansas member, you are entitled to certain rights and responsibilities. Some are guaranteed by federal law, such as the right to get a copy of your medical records, and the right to keep them private. The health care law also offers rights and protections that make coverage fairer and easier to understand. A patient’s rights and responsibilities under the Affordable Care Act are found at HealthCare.gov. If you are enrolled in Medicare, your rights are explained at Medicare.gov.

If I don’t agree with a decision made about a claim, what are my options?

If you want Blue Cross and Blue Shield of Kansas to reconsider a decision made about a claim, you have specific rights, known as the appeals process. Our complete appeals process is available in your member certificate or contract. The easiest way to locate your complete certificate or contract is online at BlueAccess. Here, you can review your contract language to see what is covered and excluded from your policy. To request a Spanish version of the appeals process, please call our Customer Service number on the back of your member identification card.

As a member, can I request a policy to be reviewed?

Following one or more appeals where a denial is overturned, your doctor or medical provider may request a medical policy be reviewed for changes. When doing so, Blue Cross and Blue Shield of Kansas requests clinical evidence be submitted to support the change. It must be clinically safe and effective, the standard of care, and medically necessary over the existing medical policy position.

At Blue Cross and Blue Shield of Kansas, our team of medical experts and leaders throughout the company continually work to offer the most affordable, comprehensive coverage possible to give our members the best health insurance our state has to offer.

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