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Policies and procedures
As a Blue Medicare HMO or Blue Medicare PPO member, you have rights regarding participation in a government program.
Coverage determinations, appeals and grievances
Review a description of our procedures for obtaining a coverage determination, or for appealing a coverage determination decision or for filing a grievance if you are dissatisfied with your Medicare prescription drug coverage for any reason.
To obtain an aggregate number of Medicare Advantage Plan grievances and exceptions, you may call Customer Service at:
Blue Medicare HMO
1-888-310-4110
Blue Medicare PPO
1-877-494-7647
TTY/TDD 1-888-451-9957
7 days a week, 8am to 8pm.
Quality assurance policies and procedures
Review the processes and systems we've put in place to evaluate prescriptions for health and safety issues. These procedures promote the appropriate use of medications by improving compliance and reducing medication errors and adverse drug interactions.
Notice of possible contract termination
PARTNERS, a subsidiary of Blue Cross and Blue Shield of North Carolina (BCBSNC), has a contract with CMS to provide a Medicare Advantage prescription drug plan. CMS is the government agency that runs Medicare. Learn how and when you will be informed if either PARTNERS or CMS decides to end the contract.
Transition process
Learn under which circumstances a temporary supply of certain noncovered or nonformulary medications may be covered for new enrollees during the transition period onto our plan.
Out-of-network coverage
If you visit an out-of-network pharmacy, your coverage is limited and your out-of-pocket costs will be higher. You will need to pay for your medication at the pharmacy and file a prescription drug claim form for reimbursement. Review the specific out-of-network benefits offered by both of our drug coverage plans.
Member rights and responsibilities
As a Medicare recipient, you have certain rights. Learn more about your Medicare rights and protections as a BCBSNC member. Also provided are instructions for disenrolling from your plan, should you decide to do so.
General Privacy Notice
This privacy notice details how Blue Medicare HMO and Blue Medicare PPO use and disclose your Protected Health Information and other information collected about you. It also outlines your rights with respect to your Personal Health Information.
Blue Medicare HMO and Blue Medicare PPO plans are offered by PARTNERS National Health Plans of North Carolina, Inc., a subsidiary of Blue Cross and Blue Shield of North Carolina (BCBSNC). PARTNERS is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. Plans are administered by BCBSNC. BCBSNC and PARTNERS do not discriminate based on color, gender, religion, national origin, age, race, disability, handicap, sexual orientation, genetic information, source of payment or health status as defined by the Centers for Medicare & Medicaid Services (CMS). All qualified Medicare beneficiaries may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or another third party. BCBSNC and PARTNERS are independent licensees of the Blue Cross and Blue Shield Association.
The information on this page is current as of 08/21/07.