Member Rights & Responsibilities

Blue Cross and Blue Shield of Vermont Member Rights & Responsibilities

Our Pledge to You

Here at Blue Cross and Blue Shield of Vermont (Blue Cross), we’re committed to creating superior member experiences and providing highly personalized service for each and every one of our interactions. We value and welcome your opinion about how we execute this pledge. We learn from your feedback and use it to make meaningful progress and innovative changes.

Member Rights and Responsibilities

As a member, you have the right to:

• Respect and privacy. You have the right to be treated with respect and dignity. We take measures to ensure your right to privacy.
• Receive information from us. We supply you with information to help you understand our organization, your rights and responsibilities as a member, our network of providers, benefits and services available to you and how to use them. You also have the right to access records we used to make decisions about your health care benefits, services, our practitioners and our providers.
• Participate in your health care. You have the right to engage in a candid discussion about appropriate or Medically Necessary treatment options, regardless of cost or benefit coverage. You have the right to participate with practitioners in making decisions about your care.
• Disagree. We welcome your complaints or appeals about our organization and the care you receive. For more information about how to file a complaint or an appeal, please call our customer service team at the number on the back of your ID card.
• Recommend changes. You have the right to suggest changes regarding our member rights and responsibilities policy. You can also provide feedback on our programs, including quality and care management.
• Nondiscrimination. You have the right to receive services from us free from all forms of discrimination including discrimination on the basis of race, color, national origin, age, disability, gender identity or sex, ethnicity, sexual orientation, or HIV-status.
• Meaningful Access. You have the right to meaningful access to all services we provide to you regardless of any disability or if you are of limited English proficiency. Where appropriate and necessary, you are entitled to free language assistance services and auxiliary aids and services.

As a member, you have the responsibility to:

• Choose a Primary Care Provider (PCP) if your plan requires a PCP.
• Present your ID card each time you receive services; and protect your ID card from improper use.
• Keep your providers informed and understand that your providers need up-to-date health information to treat you effectively. Talk to your providers about your medical history, your current health status and participate in developing treatment goals as much as possible.
• Follow plan rules and instructions for your care that you agreed to with your provider. Identify yourself as a member to providers to receive care or services and follow the policies and procedures described in your plan materials.
• Treat your providers with respect by keeping your scheduled appointments and notifying your provider ahead of time if you will be late or need to reschedule.
• Better understand your health problems by participating with your provider and the plan’s care management team (as appropriate) to develop a treatment plan.
• Pay all applicable Deductibles, Co-insurance amounts and Co-payments to your health care Providers.
• Notify us if there’s a change in your family size, address, phone number, PCP or any other change in your membership.

Revised: July 2024