Member Information

BCBSAZ Health Choice Pathway recognizes we have members of different cultures and backgrounds. These members might need special assistance such as translation services or having a doctor that speaks another language.

In addition, if you should need assistance translating the information on the BCBSAZ Health Choice Pathway site or would like to receive BCBSAZ Health Choice Pathway materials in an alternative format such as another language or large print, please contact Member Services at 1-800-656-8991, TTY 711, 8 a.m. – 8 p.m., 7 days a week. Or, you may e-mail Member Services at HCHComments@azblue.com.

Non Discrimination Notice and Multi Language Interpreter Services

Member Language Services flyer
English | Spanish

As a recipient of Medicare and as a member of BCBSAZ Health Choice Pathway, you are entitled to certain rights and also share certain responsibilities with us which are explained below.

You have the right to:

• Be treated with Fairness and Respect
• The Privacy of your Medical Records and Personal Health Information (PHI)
• See plan providers, get covered services, and get prescriptions filled within a reasonable period of time
• Know your treatment choices and participate in decisions about your healthcare
• Use Advance Directives, such as a Living Will or Power of Attorney
• Make complaints
• Get information about your healthcare coverage and costs
• Get information about BCBSAZ Health Choice Pathway, plan providers or your prescription drug coverage

How to Get More Information About Your Rights

If you have questions or concerns about your rights and protections, please call BCBSAZ Health Choice Pathway Member Services at 1-800-656-8991, TTY 711, 8 a.m. – 8 p.m., 7 days a week or you may receive free help and information from:

DES Aging and Adult Administration
State Health Insurance and Assistance Program
1789 W. Jefferson, St., 950A
Phoenix, AZ 85007

In addition, the Medicare program has written a booklet called Your Medicare Rights and Protections. To get a free copy, call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) 24 hours a day/7 days a week. Or you can visit the Medicare website at www.medicare.gov to order this booklet or print it directly from your computer.

If you would like to disenroll, there are certain times during the year when you can do so. Learn about your disenrollment options in Chapter 10 of the Evidence of Coverage (EOC):

2024 Evidence of Coverage (English)
2024 Evidence of Coverage (Spanish)

2025 Evidence of Coverage (English)
2025 Evidence of Coverage (Español)

What can you do if you think you have been treated unfairly or Your Rights are not being respected?

If you think you have been treated unfairly or your rights have not been respected, what you should do depends on your situation. If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, please let us know. Or, you can call the Office for Civil Rights in your area at:

Phoenix Office
275 W. Washington St.,
Phoenix, AZ 85007
602-542-5263
TDD: 602-542-5002
Toll free: 1-877-491-5742
Toll free TDD: 1-877-624-8090

Tucson Office
400 W. Congress, Ste, S215,
Tucson, AZ 85701
520-628-6500
TDD: 520-628-6872
Toll free: 1-877-491-5740
TDD toll free: 1-877-881-7552

For any other kind of concern or problem related to your Medicare rights and protections described in this section, you can call Member Services at 1-800-656-8991 (TTY: 711), 8 a.m. – 8 p.m., 7 days a week. You can also get help from Arizona’s SHIP.

Your Responsibilities as a Member of BCBSAZ Health Choice Pathway

As a member of BCBSAZ Health Choice Pathway, you also have responsibilities.

Your responsibilities include the following:

• To get familiar with your coverage and the rules you must follow to obtain care as a member. You may use your Evidence of Coverage and Summary of Benefits and other information we provide to you to learn about your coverage, what you have to pay, and the rules you need to follow. Please call BCBSAZ Health Choice Pathway Member Services at 1-800-656-8991, TTY 711, 8 a.m. – 8 p.m., 7 days a week if you have any questions.
• To give your doctor and other providers the information they need to care for you, and to follow the treatment plans and instructions that you and your doctors agree upon. Be sure to ask your doctors and other providers if you have any questions.
• To act in a way that supports the care given to other patients and helps the smooth running of your doctor’s office, hospitals, and other offices.
• To pay any co-payments you may owe for the covered services you receive. You must also pay for any other financial responsibilities you may incur.
• To let us know if you have any questions, concerns, problems, or suggestions.

FRAUD is any intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/her or some other person. It includes any act that constitutes fraud under applicable Federal or State law.

WASTE is unintentional misuse of Medicare funds through inadvertent error, most frequently incorrect coding, and billing.

ABUSE (of member) means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the health plan, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for healthcare. It also includes recipient practices that result in unnecessary cost to the health plan.

Types of FWA

Claim FWA: Alteration of claims, Up-coding, Incorrect coding, Double billing, Unbundling, Billing for services not provided, Submission of false documents, Billing non-covered services as covered

Member FWA; Identity theft, Prescription altering, Doctor shopping, Prescription stockpiling, Misrepresentation of eligibility or medical condition

For potential Fraud-Waste-Abuse complaints, you may call our BCBSAZ Health Choice Compliance Alert Line

Examples of fraud, waste, and abuse include letting someone use your ID card to get medical care; a provider who bills for services that you did not receive; getting a prescription that was not prescribed by a licensed and appropriate medical provider; and/or a medical provider physically abusing a BCBSAZ Health Choice Pathway member.

All Medicare Advantage plan organizations, like BCBSAZ Health Choice Pathway, must obey federal laws against retaliation. If you report fraud, waste, and abuse to BCBSAZ Health Choice Pathway, it will not affect the medical care you receive.

If you witness any instances of Medicare fraud, waste, or abuse, please call the BCBSAZ Health Choice Compliance Alert Line, toll-free at 1-800-237-0916 (TTY 711), 24 hours a day, 7 days a week. You can call this number any time and leave a confidential message.

Please leave a detailed message with the following information:

• Your name – please state whether you are a member, provider, or employee of BCBSAZ Health Choice Pathway
• Telephone number
• Include all information that supports the referral

You may remain anonymous. Your call will receive the same attention whether you identify yourself or not.

Make a Fraud, Waste and Abuse Referral

Sometimes, people need assistance to help them make decisions, ask questions, or to help them interpret the rules and regulations of a plan. If this happens, you have the right to ask someone such as a family member or friend to help you with decisions about your healthcare.

There is a special form called an “Appointment of Representative” to give someone you trust the legal authority to make decisions for you about claims, organization determinations, reconsiderations, other appeals, and grievances, should you be unable to make decisions for yourself.

If you decide that you want to appoint someone to speak on your behalf, please fill out the form below and return to BCBSAZ Health Choice Pathway by either faxing to 1-480-784-2933 or by mail to:

BCBSAZ Health Choice Pathway
8220 N. 23rd Avenue
Phoenix, AZ 85021

Note: Please make sure you make a copy and keep for your records before mailing or faxing to BCBSAZ Health Choice Pathway.

If you have questions about appointing someone to speak or make healthcare decisions on your behalf, contact BCBSAZ Health Choice Pathway Member Services at 1-800-656-8991, TTY 711, 8 a.m. – 8 p.m., 7 days a week.

Appointment of Representative Form
Appointment of Representative Form (Spanish)

BCBSAZ Health Choice Pathway will only disclose the personal health information you want disclosed. This form can be used if you want BCBSAZ Health Choice Pathway to give your personal health information to someone other than yourself.

If you decide that you want to appoint someone who we can disclose personal health information on your behalf, please fill out the form below and mail or fax your form to:

BCBSAZ Health Choice Pathway
8220 N. 23rd Avenue
Phoenix, AZ 85021
Fax: 480-760-4635

Note:
Please make sure you make a copy and keep for your records before mailing or faxing to BCBSAZ Health Choice Pathway.

If you have questions about appointing someone to speak or make healthcare decisions on your behalf, please call Member Services at 1-800-656-8991, TTY 711, 8 a.m. – 8 p.m., 7 days a week.

Authorization to Disclose PHI Form
Authorization to Disclose PHI Form (Spanish)

As one of our valued members, BCBSAZ Health Choice Pathway has you covered if the Governor, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or state of emergency in our service area.

We understand that a declared disaster or emergency could disrupt the way you normally get Medicare-covered services. That is why we will ensure that you continue to have access to covered services during the time period of the disaster or emergency.

If you are affected by a declared state of disaster or state of emergency, BCBSAZ Health Choice Pathway will:

• Permit members to receive coverage for plan benefits at non-network facilities or with non-network providers, at the same cost-sharing as a member would pay using a network provider/facility. Facilities and providers must be Medicare certified.
• Waive any referral requirements. If your plan normally requires a PCP referral for specialist services, we will waive all referral requirements during a declared state of disaster or state of emergency.
• Waive applicable medical prior authorization requirements in full.
• Allow members who have Part D coverage to fill their prescriptions at a non-network pharmacy. We will waive the one-time fill restriction should the state of disaster or state of emergency exceed thirty days. You will pay the normal out-of-network differential cost in addition to your designated copay or coinsurance.
• Permit members to refill prescription medications even if it is too soon for a refill. We will also override prior authorization, step therapy, and quantity limit restrictions for up to 90 days or until the declared state of disaster or state of emergency ends.

Your expanded access to non-network providers and facilities will end when one of the following conditions are met:

• If thirty days have elapsed since the declaration of the public health emergency or state of disaster, and no end date was identified by the original source or the Centers for Medicare and Medicaid Services (CMS), it will be considered the end of the disaster.
• The source that declared the public health emergency or state of disaster declares an end.
• CMS declares an end of the public health emergency or state of disaster.

If you have questions about your benefits, please call Member Services at 1-800-656-8991, TTY 711, 8 a.m. – 8 p.m., 7 days a week.

As an adult, you can express your wishes about the type of medical treatment you would like to have through a document known as an Advance Medical Directive for Healthcare.

An Advance Directive is a written statement of a person’s wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. Simply stated, it provides directions in the event of an accident or illness which results in your inability to communicate your wishes yourself. An Advance Directive can also allow you to designate a person (a proxy) who will make healthcare decisions for you.

An advance directive may be used to enhance your control if you should become incapacitated, accept or refuse any procedure or treatment, including life-sustaining treatment. There are four types of Advance Directives:

1. Living Will (End of life care) – A Living Will is a piece of paper that tells doctors what types of services you do or do not want if you become very sick and near death and may not be able to make health care decisions or give consent for yourself. For example, in your Living Will you might tell doctors if you want to be kept alive with machines or fed through tubes if you cannot eat or drink on your own.
2. Medical Power of Attorney – A Medical Power of Attorney is a paper that lets you choose a person to make decisions about your health care when you cannot do it yourself.
3. Mental Healthcare Power of Attorney – A Mental Healthcare Power of Attorney names a person to make decisions about your mental health care if it is found that you cannot.
4. Pre-Hospital Medical Directive (Do Not Resuscitate) – A Pre-Hospital Medical Care Directive tells providers if you do not want certain lifesaving emergency care that you would get outside a hospital or in a hospital emergency room. You must complete a special orange form. You can get a free copy of this form by calling the Bureau of Emergency Medical Services at 602-364-3150.

BCBSAZ Health Choice Pathway respects your right to make decisions about your health care and thinks that it is important for you to have one or more of these documents.

If you decide that you want to have an Advance Directive, there are several ways to get this type of form; from your lawyer, a social worker or from some office supply stores. To make it easier for our members, BCBSAZ Health Choice Pathway has posted the Living Will and Power of Attorney for Healthcare forms along with instructions on how to fill out the form.

If you should have any questions, please call Member Services at 1-800-656-8991, TTY 711, 8 a.m. – 8 p.m., 7 days a week. If you are not satisfied with our handling of advance directives, you may file a complaint with Arizona Department of Health Services (ADHS) by calling 602-542-1025 or visiting azdhs.gov.

Instructions for Completing the Health Care Directive or Writing a Living Will

1. Print your name on the first blank line. “I, MY NAME, want everyone who cares for me to know what health care I want when I cannot let others know what I want.”
2. Think about the statement, “A quality of life that is unacceptable to me means” and check each item from the list below that applies. This means that if you are in the condition described, you would want your family and doctors to stop or withdraw treatment. You would not want to continue to live in that condition. You may add any words you want on the blank lines to further describe the conditions when you would not want to continue to receive treatment.
3. Think about the statement, “There are some procedures that I do not want under any circumstances.” If you have decided that you would never want a treatment listed, check that box. If you have not decided yet, or if you would want your doctor to try these treatments, leave the box blank.
4. Think about the statement, “When I am near death, it is important to me that.” When writing a living will, you can write anything you like on these lines. Some people say, “I want hospice care.”, “I want to die at home.”, or “I want my family near me.” You may leave these lines blank if you wish.
5. You must sign this form on the reverse side and you must have your signature witnessed. The witness cannot be related to you by blood, marriage or adoption, cannot be a beneficiary to your estate, and cannot be directly involved in your healthcare. In Arizona, it is not necessary to have this form notarized, but there is a space for a notary if you desire.
6. After writing a living will, give a copy of it to your Health Care (Medical) Power of Attorney, to your family and close friends, and to your doctor. Keep a copy to take to the hospital or clinic if you become ill and need treatment.

Health Care Directive

Instructions for Completing the Health Care (Medical) Power of Attorney

1. Print your name in the first blank line.
   “I, MY NAME, as principal, designate . . .
2. Print the name of the person you have chosen to be your Health Care (Medical) Power of Attorney on the next blank line.
   “OTHER PERSON’S NAME, as my agent for all matters relating to my health care . . . “
3. Print the address and phone number of the person you have chosen to be your Health Care (Medical) Power of Attorney on the next blank line.
   “Print agent ADDRESS and PHONE”
4. You may name an alternate person to be your Health Care (Medical) Power of Attorney. This second person would take over if the first person you named is not available or is unable to make decisions for you.
   “If my agent is unwilling or unable to serve or continue to serve, I hereby appoint SECOND PERSON’S NAME as my agent.”
5. If you choose a second person as an alternate, complete the next blank line with the second person’ s address and phone number. If you do not choose a second person as an alternate, leave this last line blank.
6. You must sign this form in front of a witness.
   The witness cannot be related to you by blood, marriage or adoption, cannot be a beneficiary to your estate, and cannot be directly involved in your healthcare. In Arizona, it is not necessary to have this form notarized, but there is a space for a notary if you desire.

Give a copy of this form to your Health Care (Medical) Power of Attorney, to your family and close friends, and to your doctor. Keep a copy to take to the hospital or clinic if you become ill and need treatment.

To read more on Arizona state laws on Advance Directives, visit Life Care Planning | Arizona Attorney General (azag.gov)