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.

  • TennCare Eligibility
  • New Members
  • Medical Services / Authorizations / Claims
  • ID Cards
  • Coordination of Benefits
  • Primary Care Provider (PCP)
  • TennCare Services
  • General Questions
  • Subrogation
  • Appeals
  • Transportation
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TennCare Eligibility

How do I know if I can get TennCare?

To find out if you qualify for TennCareSM and how to apply, you’ll need to visit the TennCare site.

The Division of TennCare told me I don’t qualify for BlueCare or TennCareSelect. Can I appeal this?

If you don’t have TennCare, visit their website. Tell them you want to file an appeal. For more details, visit the TennCare appeals page.

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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 1-888-816-16801-888-816-1680 or 1-800-254-75681-800-254-7568 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?

You’ll find an overview of covered service on the Your Health page. Complete details are in your member handbook.

When do I need prior authorization for care?

Your benefits cover the most common kinds of care, but certain services need an OK from us. This is called prior authorization.

Your provider should let you know if a service needs an OK. They’re also responsible to get an OK before doing any special services. If the provider isn’t sure, they should call us.

For more details, go to the Your Health page.

Can I file my own claim?

No. Only your health care provider can file claims.

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ID Cards

How can I get a replacement or temporary ID card?

Contact us if you need a replacement ID card.

You can also get a temporary ID card through your online account. Register or log in to at top right.

Please know we can only send a new ID card if TennCare Connect has your current address. Visit their website.

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

Yes. You should receive it within 7 to 10 business days after you tell us about the change.

If you haven’t received your ID card, please contact us. Your health care provider can also call us to verify your coverage while you wait for your new ID card.

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Coordination of Benefits

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

Visit TennCare Connect to see if it would affect your coverage. They can be reached at 1-855-259-07011-855-259-0701.

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

The other type of medical insurance is your primary coverage. This means it would pay first.

If you have other health insurance:

Tell your provider, so they can bill the right insurance. Show all of your health insurance cards, including Medicare.

Visit TennCare Connect to report your other coverage to TennCare.

Tell us so that we can update our records. Call us.

You can find all the details on how TennCare works with other insurance in your member handbook on page 7.

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Primary Care Provider (PCP)

Who’s my PCP?

We assign primary care providers (PCPs) to most BlueCare and TennCareSelect members. If you’ve been assigned a PCP, their name is listed on your Member ID card.

Your PCP is your main provider of care. You should share all of your health information with them, including if you see another provider, go to the ER or a walk-in-clinic. This will help your PCP provide you with better care.

How can I change my PCP?

There are three ways to 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.

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.

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

Are vision and dental services covered?

TennCare pays for some vision and dental services depending on your age and your health plan benefits.

If you’re under the age of 21:
Through age 20, routine vision care and dental services are part of your or your child’s plan.

If you’re 21 or older:
Vision services are limited to medical evaluation and management of abnormal conditions and disorders of the eye. The first pair of cataract glasses or contact lens/lenses after cataract surgery are covered.

Basic dental care is covered only for adults 21 and older who are members of Employment and Community First CHOICES. Covered services include dental exams, cleanings and fillings.

If you need services we don’t provide, please see the More Local Help section of our website. Your local health department or other groups may be able to help.

What’s TennCare Kids?

TennCare Kids is a program for members under the age of 21 that provides free well-child checkups and follow-up care. Find more details here.

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

Babies, children and teens need regular checkups to stay healthy. We’ve provided a quick reference guide to help you keep track of your child's recommended screenings.

How do I make a well-child appointment?

Simply call your child’s PCP to make an appointment. Their name is listed on your child’s ID card. If you need help, please contact us.

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?

Please see your member handbook for a list of non-covered services. You can also contact us.

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

Yes. TennCare will pay for your baby’s PKU test. All babies born in U.S. hospitals must be tested for this condition. Without early treatment, PKU can cause brain damage and other problems.

TennCare also pays for PKU treatment, including licensed medical services and special formulas to feed babies.

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 1-888-816-16801-888-816-1680.

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

These products are provided by Medline Industries*. They’re a trusted partner that specializes in this type of care.

If you need incontinence supplies, please ask your health care provider to fax your prescriptions to Medline at 1-866-557-27371-866-557-2737.

Medline Customer Service 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.

*Medline 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?

Yes. Those services are covered as medically necessary.

Is Hospice Care covered?

Yes. It’s included as medically necessary. But care must be provided by a Medicare-Certified Hospice.

Is Physical Therapy covered?

Yes, it’s covered for:

  • Members who are age 21 and older as medically necessary. Care must be provided by a licensed physical therapist to restore, improve or stabilize impaired functions.
  • Members younger than age 21 as medically necessary. Care must meet TennCare Kids requirements.

Is Speech Therapy covered?

Yes, Speech Therapy is covered for:

  • Members age 21 and older as medically necessary. And when provided by a licensed speech therapist to restore speech (as long as there is continued medical progress) after a loss or impairment. The loss or impairment must not be caused by a mental, psychoneurotic, or personality disorder.
  • Members younger than age 21 as medically necessary. Care must meet TennCare Kids requirements.

Are Chiropractic services covered?

Yes. Chiropractic Services are covered for:

  • Members age 21 and older, when determined to be a cost-effective alternative by the MCO.
  • Members younger than age 21 as medically necessary. Care must meet TennCare Kids requirements.

Are Tissue Transplants covered by my TennCare plan?

Yes. Tissue Transplants are covered for members younger than age 21 as medically necessary. Care must meet TennCare Kids requirements.

If you are 21 and older all medically necessary and non-investigational/experimental organ and tissue transplants, as covered by Medicare.

Is Reconstructive Breast Surgery covered by my TennCare plan?

Reconstructive Breast Surgery is covered in line with TCA 56-7-2507. This coverage includes:

  • All stages of reconstructive breast surgery on a diseased breast as a result of a mastectomy
  • Any surgical procedure on the non-diseased breast to establish symmetry between the two breasts in the manner chosen by the physician
  • Surgery on a non-diseased breast only if it’s performed within five years of the date the reconstructive breast surgery was performed on a diseased breast

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

Yes. Both inpatient and residential and outpatient substance use disorder benefits are covered by your TennCare plan.

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

Yes. But only specified services and levels of reimbursement, including Assisted Care Living Facility, Community Living Supports and Community Living Supports — Family Model. We can help decide which one is right for you.

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General Questions

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

We recommend that you first call the provider who is billing you. You can contact us for additional help.

What should I do if I move?

It’s important that TennCare knows about your move, so they can continue to send you health care information. If they don't have your current address, you could lose your TennCare coverage.

Visit TennCare Connect to tell TennCare about any change of address.

If you have questions, you can also contact us.

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 1-866-926-98031-866-926-9803 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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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.

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

Yes. Please mark "NO" to the first question and tell us the fall occurred on your property.

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

If you were involved in a car accident or accident at work, someone else may be responsible to provide your health care. Call BlueCare at 1-800-468-96981-800-468-9698 or TennCareSelect at 1-800-263-54791-800-263-5479, and we will provide the assistance you need.

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

You have the right to appeal if any of your services are reduced, suspended or stopped completely.

Please contact us. If we can’t solve your problem, you can call TennCare Solutions at 1-800-878-31921-800-878-3192 for help with an appeal. In most cases, you will receive a decision within 90 days.

You can learn more about appeals in the Member Rights section of our website.

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

TennCare can make a decision sooner if you have an emergency. An emergency means waiting could endanger your health.

If you think you have an emergency, you should ask TennCare for an emergency appeal. Your appeal may go faster if your health care provider signs your appeal. For more information, see the Member Rights section of our website.

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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.

How can I get transportation for my appointment?

Simply schedule a ride with Southeastrans*, 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.

*Southeastrans is an independent company serving BlueCare Tennessee members for transportation and does not provide BlueCare Tennessee branded products or services.