Frequently Asked Questions

We’ve answered some of the most commonly asked questions about your plan to help you get the most out of it. You can check here any time you want answers. And if you have more questions, contact us. We’re here to help.

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TennCare Eligibility

How do I know if I can get TennCare?
The Division of TennCare told me I don’t qualify for BlueCare or TennCareSelect. Can I appeal this?

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New Members

When will I get my BlueCare or TennCareSelect ID card?
You should receive your ID card 7 to 10 calendar days after we receive your information from TennCare.
If you haven’t received your ID card, please contact us. You can download a temporary ID card from your online account. Register or log in. Your health care provider can also call us to verify your coverage while you wait for your new ID card.
For more information, please see the Getting Started page.
Will I get separate ID cards for vision, dental, and drug (pharmacy) benefits?
If you’re covered for vision and dental, you’ll use your regular Member ID card for these benefits.
You’ll get a separate ID card for your drug benefits. If you haven't received it, please call your pharmacy benefit manager.* Call 1-888-816-1680 or 1-800-254-7568 for the Spanish line.
*Pharmacy benefits are provided by your pharmacy benefits manager, an independent company that does not provide BlueCare Tennessee branded products and services. Your pharmacy benefit manager is solely responsible for administering pharmacy benefits.

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Medical Services / Authorizations / Claims

How do I know what medical services are covered?

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When do I need prior authorization for care?

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Can I file my own claim?

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ID Cards

How can I get a replacement or temporary ID card?

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Will I get a new ID card if I change my primary care provider (PCP)?

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Coordination of Benefits

If I get insurance through my work, will I lose my TennCare coverage?

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I have TennCare and another type of medical insurance. Which one is considered primary?

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If you have other health insurance:

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Primary Care Provider (PCP)

Who’s my PCP?

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How can I change my PCP?
You can change your PCP as often as you need, and the change is immediate once you tell us. You’ll get a new Member ID card with the name of your new PCP listed.
There are three main ways to do this.
Visit your online account at the top right of this page. Once you log in, you’ll find instructions on how to choose a new PCP online.
Contact us to help you find a new provider.
Choose a new PCP yourself. If you’re choosing a PCP on your own, please call their office to make sure they’re still in our provider network and taking new patients. The provider can make the PCP change on your behalf when you contact them. Or you can call us to update the name of your new PCP.
You can also mail, email or fax us a completed PCP Change Request form.
Email: FAX_pcp@bcbst.com
Fax: 1-888-261-9025
Mail: Print and mail the form. Find more details in your member handbook.

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What happens if my PCP no longer accepts BlueCare or TennCareSelect?
We’ll send you a letter asking you to find a new PCP. There are three ways you can do this.
Visit your online account at top right. Once you log in, you’ll find instructions on how to choose a PCP.
Ask us to help you find a new provider. Simply contact us.
Once you’ve chosen a PCP, please send us a completed PCP Change Request or call to tell us the name of your new PCP. You’ll find instructions on the Change Request form in your member handbook on page 104.
If you are choosing a PCP on your own, please call their office to make sure they’re still in our provider network and taking new patients. Once you change providers, you’ll get a new Member ID card with the name of your new PCP listed.

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TennCare Services

Does my plan cover vision and dental services?
Vision:
TennCare pays for some vision care. What’s covered is based on your age.
If you’re under age 21:
Routine vision care is part of your plan.
If you’re 21 or older:
Your plan covers vision services related to:
Medical evaluation
Treatment for eye problems and diseases
BlueCare and TennCareSelect also cover the first pair of cataract glasses or contact lens/lenses after cataract surgery.
CoverKids covers needed medical eye care for pregnant members age 19 and older. These members can get one pair of glasses or contact lenses after cataract surgery. Routine vision exams aren’t covered.

Dental:
Your plan includes dental benefits* if you’re:
A BlueCare member
A TennCareSelect member
A CoverKids member aged 18 or younger
Are you aged 21 or older and a member of the Employment and Community First CHOICES program? Your plan covers additional dental benefits.
Ready to learn more? Visit TennCare’s Dental Services webpage for more information.
Need a service we don’t cover?
Please see our More Local Help page. Your local health department or other groups may be able to help.
*TennCare Medicaid and CoverKids:
Your plan covers facility, medical and anesthesia services that aren’t provided by a dentist (or in a dentist office) if they’re related to a covered dental service. A covered dental service is care Renaissance covers. Or it may be a dental service the Department of Intellectual & Developmental Disabilities (DIDD) covers.
Employment and Community First CHOICES (adults ages 21 and older):
Your plan covers facility, medical and anesthesia services that aren’t provided by a dentist (or in a dentist office) if they’re related to a covered dental service. A covered dental service is care Renaissance covers. Or it may be a dental service the DIDD covers. This also includes dental services covered by an MLTSS program for people with intellectual and developmental disabilities.
What’s TennCare Kids?
How often does my child need a well-child checkup?
How do I make a well-child appointment?
Is a sports physical the same as a well-child checkup?
No. While children need checkups to play sports, they’re not the same as well-child or well-teen checkups.
Sports physicals often focus on the child’s ability to play a sport. A well-child checkup is a complete exam. The provider will check your child’s physical and mental development and make sure all vaccines are up to date. Well-child visits can help find and prevent problems, so you should keep every appointment.
What is a non-covered service?
Will TennCare pay for PKU (Phenylketonuria) testing and treatment?
Are diabetes testing supplies and education covered?
When it’s medically necessary, TennCare provides coverage for
Diabetic equipment and supplies
Training, education and counseling on how to manage diabetes

Also, many kinds of insulin and oral diabetes medicines are on the Auto Exemption List (it used to be called the pharmacy “short-list”). This means they don’t count against your monthly drug limit. To see the list:
Go to the TennCare site.
Click on the Auto Exemption List
If you have any problems getting your diabetic medicines or testing supplies covered, please call your pharmacy benefit manager. They’re the company that handles your prescription drug coverage. You can reach them at 1-888-816-1680.
How do I find a provider for incontinence (disposable) products?
These products are provided by Home Care Delivered (HCD)*. They’re a trusted partner that specializes in this type of care.
If you need incontinence supplies, please call us at 804-200-7300 or 800-565-5644, or you may ask your health care provider to fax your prescriptions to HCD at 1-804-823-4118.
If your health care provider faxes your prescription over, the HCD Customer Service team will call to confirm your information and ship your supplies directly to your home. They’ll also check with you to make sure you are receiving the service and supplies you need.
If you have other questions, please contact us.
*Home Care Delivered Industries is an independent company that supplies medical products for BlueCare Tennessee members.
Are Physician Inpatient Services, Physician Outpatient Services, Community Health Clinic Services and other Clinic Services covered?

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General Questions

Who do I call if I have a question about a bill I received?

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What should I do if I move?

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Is my identity safe?
We want you to feel confident your personal information is safe. So we work with Experian*, one of the world’s leading financial firms, to provide you with the following free services:.
ProtectMyID (each covered member age 18 or older will need to sign up on their own)
− Credit monitoring
− Fraud protection and support
FamilySecure
− Credit monitoring for all children under age 18 in your home
To sign up for these services:
Log in to your online account.
Click on the ID Protection link. You’ll be taken to a secure site to enroll in the services.
Or call Experian at 1-866-926-9803 if:
You’re 18 or older, you’ll need to use Engagement Reference #PC101139 for ProtectMyID .
You’re under 18, use Engagement Reference #PC101140 for FamilySecure.

* Experian is an independent vendor that administers identity protection services on behalf of BlueCare Tennessee.

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What do I do if it’s not safe to share my home address?
If sharing your home address could be dangerous for you, the Safe at Home program can help. It’s a Tennessee state program to help keep your address safe.
You may be able to participate if you’re affected by things like:
Domestic abuse
Stalking
Human trafficking
Rape
Sexual battery
Other sexual offenses
If you’re approved, you’ll get a “substitute” address to use for all state and local government purposes, like registering your car or signing up for public utilities. You can also use it when you need to show proof of residency. The address works for your children, too. You can use this address for things like public school or public benefits enrollment. Your mail will still come to your home, even with this new address.
It doesn’t cost you anything to be part of this program. You can learn more at sos.tn.gov/safeathome.

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How do I sync my data?

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How can I get help with internet access?
The U.S. has a new program to help you get high-speed internet access. If you qualify, you may be able to get $30 a month toward an internet service plan. And if you live on Tribal lands, you may be able to get $75 a month.
This program also offers other special deals on internet plans. That means if you get the benefit and use it on one of these plans, you won’t pay any extra costs. You can learn more and see if you qualify at getinternet.gov.

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Subrogation

I received a subrogation questionnaire in the mail. What’s subrogation and why did I get this?
Subrogation is the legal process that BlueCare or TennCareSelect uses to recover payment that another party is legally responsible to pay.
For example:
Automobile or Motorcycle Insurance
Medical Malpractice (a provider made a mistake)
Workers' Compensation (you’re injured at work)
Liability Insurance or Home Owner Insurance (if you were injured at a business or someone else’s home)
If you received a questionnaire, that means we’re processing a claim that needs to be reviewed for possible subrogation. Please return the completed form by mail or fax. You’ll find directions on the questionnaire.

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If I fall in my home, do I need to complete the questionnaire mailed to me?

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I was involved in an accident. What should I do?

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Appeals

I’m not getting the health care services I deserve. Should I file an appeal?

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What if I can't wait 90 days to hear the decision about my appeal?

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Transportation

Does my insurance cover transportation?
TennCare members can get free rides to the pharmacy and covered appointments. You need to be a TennCare member on the day of your trip. You need to be visiting a TennCare provider as well.
You can also get a free ride to an out-of-network provider if you get an OK from us. Members who also have Medicare can get a ride to any provider that accepts Medicare.
If you’re a member of Employment and Community First CHOICES, a budget for community transportation may also be in your support plan. Call your support coordinator to ask if you have this service and how to use it. If you’re not sure of your support coordinator’s name and phone number contact us.
Nonemergency transportation services are provided in accordance with federal law and the Tennessee Division of TennCare’s rules and P&Ps. Nonemergency transportation services are provided to take members to and from TennCare covered services.
Emergency Air and Ground Ambulance Transportation is covered, as medically necessary.

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How can I get transportation for my appointment?
Simply schedule a ride with Verida*, our trusted transportation partner. For your convenience, you can schedule your ride online or over the phone.
For more information, visit our One-on-One Help page.
If you’re a member of Employment and Community First CHOICES, a budget for community transportation may also be in your support plan. Call your support coordinator to ask if you have this service and how to use it. If you’re not sure of your support coordinator’s name and phone number contact us.
*Verida is an independent company serving BlueCare Tennessee members for transportation and does not provide BlueCare Tennessee branded products or services.

Frequently Asked Questions

Will I get separate ID cards for vision, dental, and drug (pharmacy) benefits?

How do I know what medical services are covered?

When do I need prior authorization for care?

Can I file my own claim?

How can I get a replacement or temporary ID card?

Will I get a new ID card if I change my primary care provider (PCP)?

If I get insurance through my work, will I lose my TennCare coverage?

I have TennCare and another type of medical insurance. Which one is considered primary?

If you have other health insurance:

Who’s my PCP?

How can I change my PCP?

What happens if my PCP no longer accepts BlueCare or TennCareSelect?

Does my plan cover vision and dental services?

What’s TennCare Kids?

How often does my child need a well-child checkup?

How do I make a well-child appointment?

Is a sports physical the same as a well-child checkup?

What is a non-covered service?

Will TennCare pay for PKU (Phenylketonuria) testing and treatment?

Are diabetes testing supplies and education covered?

How do I find a provider for incontinence (disposable) products?

Are Physician Inpatient Services, Physician Outpatient Services, Community Health Clinic Services and other Clinic Services covered?

Is Hospice Care covered?

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Is Occupational Therapy covered by my TennCare plan?

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Is Physical Therapy covered?

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Is Speech Therapy covered?

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Are Chiropractic services covered?

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Does my TennCare plan cover organ and tissue transplants and donor organ procurement?

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Is Reconstructive Breast Surgery covered by my TennCare plan?

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Are Inpatient/Residential and Outpatient Substance Use Disorder Benefits covered by my TennCare plan?

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Are Community-Based Residential Alternatives available for Choices Group 3 members?

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Does my plan cover psychiatric inpatient hospital services?

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Who do I call if I have a question about a bill I received?

What should I do if I move?

Is my identity safe?

What do I do if it’s not safe to share my home address?

How do I sync my data?

How can I get help with internet access?

I received a subrogation questionnaire in the mail. What’s subrogation and why did I get this?

If I fall in my home, do I need to complete the questionnaire mailed to me?

I was involved in an accident. What should I do?

I’m not getting the health care services I deserve. Should I file an appeal?

What if I can't wait 90 days to hear the decision about my appeal?

Does my insurance cover transportation?

How can I get transportation for my appointment?

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Is Hospice Care covered?

Is Occupational Therapy covered by my TennCare plan?

Is Physical Therapy covered?

Is Speech Therapy covered?

Are Chiropractic services covered?

Does my TennCare plan cover organ and tissue transplants and donor organ procurement?

Is Reconstructive Breast Surgery covered by my TennCare plan?

Are Inpatient/Residential and Outpatient Substance Use Disorder Benefits covered by my TennCare plan?