Member Rights and Responsibilities

As a Blue Cross and Blue Shield of North Carolina (Blue Cross NC) member, you have certain rights and responsibilities.

Your Rights

As a Blue Cross NC member, you have the right to:

  • Receive information about your coverage and your rights and responsibilities as a member.
  • Receive, upon request, facts about your plan, including a list of doctors and health care services covered.
  • Receive polite service and respect from Blue Cross NC.
  • Receive polite service and respect from the doctors who are part of the Blue Cross NC networks.
  • Receive the reasons why Blue Cross NC denied a request for treatment or health care service, and the rules used to reach those results.
  • Receive, upon request, details on the rules used by Blue Cross NC to decide whether a procedure, treatment, site, equipment, drug or device needs prior approval.
  • Receive, upon request, a copy of Blue Cross NC's list of covered prescription drugs. You can also request updates about when a drug may become covered.
  • Receive clear and correct facts to help you make your own health care choices.
  • Play an active part in your health care and discuss treatment options with your doctor without regard to cost or benefit coverage.
  • Participate with practitioners in making decisions about your health care.
  • Expect that Blue Cross NC will take measures to keep your health information private and protect your health care records.
  • Voice complaints and expect a fair and quick appeals process for addressing any concerns you may have with Blue Cross NC.
  • Make recommendations regarding Blue Cross NC's member rights and responsibilities policies.
  • Receive information about Blue Cross NC, its services, its practitioners and providers and members' rights and responsibilities.
  • Be treated with respect and recognition of your dignity and right to privacy.

Your Responsibilities

As a Blue Cross NC member, you should:

  • Present your Blue Cross NC ID card each time you receive a service.
  • Read your Blue Cross NC benefit booklet and all other Blue Cross NC member materials.
  • Call Blue Cross NC when you have a question or if the material given to you by Blue Cross NC is not clear.
  • Follow the course of treatment prescribed by your doctor. If you choose not to comply, advise your doctor.
  • Provide Blue Cross NC and your doctors with complete information about your illness, accident or health care issues, which may be needed in order to provide care.
  • Understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
  • Make appointments for non-emergency medical care and keep your appointments. If it is necessary to cancel an appointment, give the doctor's office at least 24-hours notice.
  • Play an active part in your health care.
  • Be polite to network doctors, their staff and Blue Cross NC staff.
  • Tell your place of work and Blue Cross NC if you have any other group coverage.
  • Tell your place of work about new children under your care or other family changes as soon as you can.
  • Protect your Blue Cross NC ID card from improper use.
  • Comply with the rules outlined in your member benefit guide.