Your Health Plan Q&A

We want to make it easy for you to use your benefits, so we’ve provided answers to common questions here.  If you have additional questions, please send us an email or call between the hours of 8 a.m. and 6 p.m, Eastern Time. We’re here to help.

BlueCareSM Customer Service: 1-800-468-9698
TennCareSelect Customer Service: 1-800-263-5479.

 

TennCareSM Eligibility

 

  • To find out if you qualify for TennCare and how to apply, you'll need to visit the TennCare website.
  • If you don't have TennCare, call the TennCare Connect at 1-855-259-0701 for help. Tell them you want to file an appeal. For more details, visit the TennCare appeals page.

New Members

  • 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 call or email our Customer Service team. You can download a temporary ID card from the BlueAccess section of our website. Register or login to BlueAccess at top right. 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 New Members page.
  • 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 your pharmacy card, please call Magellan* at 1-888-816-1680 or 1-800-254-7568 for the Spanish line.

Medical Services/Authorizations/Claims

  • 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 prior authorization. They're also responsible to get an OK before doing any special services. If the provider is unsure, they should call Customer Service.
  • For more details, please see the Prior Authorization section of our website.
  • No, only your health care provider can file claims.

ID Cards

  • You can get a replacement ID card by calling or sending an email to our Customer Service team.
  • You can get a temporary ID card through BlueAccess. Register or login to BlueAccess at top right.
  • Please know we can only send a new ID card if the TennCare Connect has your current address. They can be reached at 1-855-259-0701, Monday through Friday, from 7 a.m. to 7 p.m., Eastern Time.
  • Yes. You should receive it within 7 to 10 business days after you tell us about the change.
  • If you have not received your ID card, please call or email our Customer Service team. Your health care provider can also call us to verify your coverage while you wait for your new ID card.

Coordination of Benefits

  • Please call the TennCare Connect to ask if it would affect your coverage. They can be reached at 1-855-259-0701.
  • The other type of medical insurance is your primary coverage. This means it would pay first.
  • Tell your provider, so they can bill the right insurance. Show all of your health insurance cards, including Medicare.
  • Tell the TennCare Connect, so TennCare knows about your other coverage. They can be reached at 1-855-259-0701.
  • Tell us so that we can update our records. Call Customer Service

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

Primary Care Provider (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.

There are three ways to do this

  • Visit the BlueAccess section of our website at top right. Once you login, you'll find instructions on how to choose a PCP.
  • Ask us to help you find a new provider. Simply call or email our Customer Service team.
  • 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.

We'll send you a letter asking you to find a new PCP. There are three ways you can do this.

  • Visit the BlueAccess section of our website at top right. Once you login, you'll find instructions on how to choose a PCP.
  • Ask us to help you find a new provider. Simply call or email our Customer Service team.
  • 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.

TennCare Services

  • 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:

We'll pay for routine vision care and dental services as part of TennCare Kids.

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.

  • 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 in our Healthy Kids & Teens section.
  • 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.
  • 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 call or email our Customer Service team.

  • 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.
  • 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.
  • 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:

    Or you can call the TennCare Connect at 1-855-259-0701.

    If you have any problems getting your diabetic medicines or testing supplies covered, please call Magellan HealthSM*. They’re the company that handles your prescription drug coverage. You can reach them at 1-888-816-1680.

  • These products are provided by Medline Industries* -- 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 1-866-557-2737.
  • 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 call or email our Customer Service team.

General Questions

  • We recommend that you first call the provider who is billing you. You can also call or email our Customer Service team for additional help.

  • It’s important that TennCare knows about your move, so they can continue to send your health care information. If they don't have your current address, you could lose your TennCare coverage.
  • Please call the TennCare Connect at 1-855-259-0701 to tell them about any change of address.
  • If you have questions, you can also call or email our Customer Service team.

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:

  • Login to your BlueAccess 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 .
  • If you’re under 18, use Engagement Reference #PC101140 for FamilySecure.

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.

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

  • 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 1-800-468-9698 or TennCareSelect at 1-800-263-5479, and we will provide the assistance you need.

Appeals

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

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

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

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. As well, you need to be visiting a TennCare provider.
  • You can also get a free ride to an out-of-network provider if you have authorization 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 call or email Customer Service.
  • 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 Get a Ride 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 call or email Customer Service.

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

Pharmacy benefits are provided by Magellan, an independent company that does not provide BlueCare Tennessee branded products and services. Magellan is solely responsible for administering pharmacy benefits.

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

Medline Industries is an independent company that supplies medical products for BlueCare Tennessee members.


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