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Member rights & responsibilities

As a member, you have a certain rights and responsibilities, such as filing appeals, subrogation, privacy, nondiscrimination and more.

View your rights

Report fraud and abuse

Find out how to spot and report fraud such as false claims, misrepresentation of services, medically unnecessary services and more.

Report fraud

File an appeal if a claim is denied

Members have a right to file an appeal to request the review of a denial of a claim in whole or in part.

View appeals

Receive prior approval for services

Some benefits provided by your Health Advantage health plan may require approval in advance of receiving medical services.

View prior approval

Select or change your primary care physician (PCP)

At the time of enrollment, you must select a primary care physician (PCP). Your Member ID card will list the PCP you select. Each covered member of your family also must select a PCP.

Select PCP

What is subrogation?

Subrogation refers to the legal right of an insurance company — after payment of a loss — to recover monies from the responsible party's insurance carrier. For BlueAdvantage, it refers to those times when another insurance carrier may be responsible for payment of medical care.

View subrogation

Obtain a referral to a specialist

Your primary care physician may refer you to an in-network specialist. For a referral to an out-of-network specialist, your PCP must submit an out-of-network referral request for possible coverage authorization.

View referral process