Medicare member rights and responsibilities

We will tell you what you can do if you think you are being treated unfairly or your rights are not being respected.

If you want Medicare publications about your rights, you may call and request them at 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. You can call 24 hours a day, seven days a week.

You have the right to be treated with dignity, respect, and fairness at all times. We must obey laws against discrimination that protect you from unfair treatment. These laws say that we cannot discriminate against you (treat you unfairly) because of your race or color, age, religion, national origin, or any mental or physical disability you may have.

If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, please let us know. You can also reach the Office for Civil Rights at 800-368-1019 (TTY 800-537-7697), or you can contact the regional Office for Civil Rights in your area.

Southern Regional Office for Civil Rights

The Southern Regional Office for Civil Rights covers North Carolina, Alabama, Florida, Georgia, Kentucky, Mississippi, South Carolina, and Tennessee.

Attention: If you require language assistance services, these are available to you free of charge. Please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

There are federal and state laws that protect the privacy of your medical records and personal health information. We keep your personal health information private as protected under these laws. Any personal health information (PHI) that you give us when you enroll in this plan is protected.

We will make sure that unauthorized people do not see or change your records. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who is not providing your care or paying for your care.

There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used.

We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. For example, you have the right to look at your medical records, and to get a copy of the records (there may be a fee charged for making copies).

You also have the right to ask us to make additions or corrections to your medical records (if you ask us to do this, we will review your request and determine whether the changes are appropriate).

You have the right to know how your health information has been given out and used for non-routine purposes. If you have questions or concerns about the privacy of your personal information and medical records, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

You should get all of your prescriptions filled from an in-network pharmacy, that is, from pharmacies that contract with Blue Cross NC.

You have the right to go to any network pharmacy in order to get your prescriptions filled at the benefit level.

You have the right to timely access to your prescriptions. "Timely access" means that you can get your prescriptions filled within a reasonable amount of time.

You have the right to know about the different Medication Management Treatment Programs we offer and in which you may participate. You have the right to be told about any risks involved in your care. You have the right to refuse treatment. This includes the right to stop taking your medication. If you refuse treatment, you accept responsibility for what happens as a result of refusing treatment.

You have the right to get a detailed explanation from us if you believe that a network pharmacy has denied coverage for a drug that you believe you are entitled to get or care you believe you should continue to get.

You have the right to make a complaint if you have concerns or problems related to your coverage or care. "Appeals" and "grievances" are the two different types of complaints you can make. Which one you make depends on your situation. You can make a complaint on the Medicare complaint form⁠.

If you make a complaint, we must treat you fairly (i.e., not discriminate against you). You have the right to get a summary of information about the appeals and grievances that members have filed against us in the past. To get this information, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

This website tells you what you have to pay for prescription drugs as a member of Blue Cross NC. If you need more information, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

You have the right to an explanation from us about any bills you may get for drugs not covered by your plan. We must tell you in writing why we will not pay for a drug, and how you can file an appeal to ask us to change this decision.

You have the right to get information from us about Blue Cross NC and our plans. This includes information about our financial condition and about our network pharmacies.

To get any of this information, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

You have the right to disenroll from Blue Medicare Plans during certain periods by giving written notice to Blue Cross NC of your intent to do so. Coverage will end on the last day of the month following the date that Blue Cross NC receives your written request.

To end your coverage, you may send written notice to Blue Medicare Plans, PO Box 30010, Durham, NC 27702. You will receive an acknowledgement of your disenrollment from Blue Cross NC.