FREQUENTLY ASKED QUESTIONS
Privacy and Security
Get answers to common questions about privacy and security with Blue Cross and Blue Shield of Illinois. Learn how we safeguard your information and how you can protect your data.
Absolutely. Since 1996, the Health Insurance Portability and Accountability Act (HIPAA) has helped protect your privacy.
It’s the Law
BCBSIL is required by federal and state law to give a Privacy Practices Notice to plan members. The notice explains how BCBSIL can use and share a member’s health and financial information. The notice is different than the website Privacy Statement. If you are covered by a health plan, you should get a Privacy Practices Notice each time you visit a hospital, provider, dentist or eye doctor.
BCBSIL Privacy Practices Notice
Our Pledge to You
BCBSIL is committed to the highest standards of business ethics and integrity. We strictly observe and comply with the laws and regulations governing our business operations. Other safeguards include:
The Code of Ethics and Conduct for our employees.
A Vendor Code of Ethics and Conduct for vendors who conduct business with us and/or provide services to our customers.
More Safeguards
In addition, BCBSIL has its own Special Investigations Department (SID) to fight fraud. The SID staff includes people from diverse backgrounds such as:
- Insurance industry experts.
- Law enforcement.
- Medical providers.
- Professional coders.
SID also has a Data Intelligence Unit to partner with SID investigators to find and stop fraud, waste and abuse. When appropriate, SID refers fraud cases for criminal prosecution.
Health care fraud, waste and abuse has a negative affect on the health care industry and our nation. They cost billions of dollars each year. It may lead to:
- Higher health care costs.
- Limited health care resources.
- Lower consumer confidence in our health care system.
Examples of health care fraud include
- a provider billing for a service that was never performed
- a provider billing for a more expensive service, supplies or equipment than what was really provided
- a provider rendering the same service twice
Your Private Health Information (PHI)
Aside from billing fraud, your PHI can be at risk. PHI is your medical records and other health-related documents that list your private data:
- Address
- Birthdate
- Social Security number
If a document doesn’t relate to your health, it may not be viewed as PHI. If you’re not sure what is and isn’t PHI, ask yourself:
- Can I be identified by anything shown on the document?
- Is my name on the document?
- Does the document show anything related to my health condition?
- Is the account I used to pay for my health care listed?
Helpful Hints
Here are tips to avoid fraud and scams:
- Never loan your member ID card to someone else.
- If your BCBSIL member ID card or Social Security number card are lost or stolen, report it immediately.
- Never share your information if medical services or equipment are offered to you for free.
If you suspect fraud, BCBSIL offers the following ways to report it:
Online
Phone
Call the customer service number on your member ID card or 1-877-361-7594.
Privacy Office
Blue Cross and Blue Shield of Illinois
300 E. Randolph St.
Chicago, IL 60601-5099
Providers are licensed health care facilities, programs, agencies, doctors or other professionals who deliver health care services.
What’s the Difference
Fraud is running (or attempting) a scheme to defraud a health care benefit program, or obtain (by false or fraudulent pretenses, representations or promises) money or property overseen by that program.
Waste is using more services that result in unnecessary costs to the health care system. Criminally negligent actions are usually the cause, not misusing resources.
Abuse is payment for goods or services to someone who is not entitled to it. Or the individual or entity has not knowingly/intentionally misrepresented facts to obtain payment.
What You Can Do
- Call our Provider Fraud Hotline at 1-800-543-0867 to report suspected health care fraud.
- Always keep your member ID card and health records in safe place.
- Ask providers to explain why a service is necessary. If in doubt, get a second opinion by another doctor.
- Review and understand your Explanation of Benefit (EOB) statements.
- Verify that you had exams, tests or treatments with the listed provider.
- Count your pills every time you pick up a prescription.
BCBSIL’s credit monitoring alerts you when we notice suspicious activity on your credit reports. This helps us identify and stop a privacy or security breach before it happens. This credit monitoring is a basic service offered to all our members on an opt-in basis.
We strive to help combat privacy and security violations. Our identity protection services are offered by leading identity protection services companies to eligible BCBSIL members, where permitted by local regulation and subject to certain local market limitations. This includes:
- Credit monitoring – Monitors activity that may affect credit.
- Fraud detection – Identifies potentially fraudulent use of identity or credit.
- Fraud resolution support – Assists members in addressing issues that arise in relation to credit monitoring and fraud detection.
Identity protection services are offered to eligible members as a convenience. They should not be considered covered health benefits or services, health insurance, a guarantee of coverage under your health benefit plan, or legal, financial or medical advice.
A one-time passcode is a security method that’s used for a single login attempt or transaction. It enables a user to log into a network or application. Its purpose is to minimize the risk of fraudulent attempts and maintain high security.
Specifically, it:
- Delivers a computer-generated code delivered by email, short message service (SMS), or hardware token.
- Is a form of authentication or verification that proves you are who you say you are while using your mobile device or computer.
- Can only be used once.