Privacy and Security

Absolutely. Since 1996, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has helped protect your privacy. If you are covered by a health plan, you should get a Privacy Practices Notice each time you visit a hospital, doctor, dentist or eye doctor. 

It’s the Law

Blue Cross and Blue Shield of Montana is required by federal and state law to give a Privacy Practices Notice to plan members. The notice explains how BCBSMT can use and share a member’s health and financial information. The notice is different than the website Privacy Statement. 

BCBSMT Privacy Practices Notice

Our Pledge to You

BCBSMT 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 those vendors who conduct business with us and/or provide services to our customers.

More Safeguards

In addition, BCBSMT 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 costs Americans billions of dollars each year. It leads to: 
 

• Higher health care costs
  
• Limited health care resources
  
• Lower consumer confidence in our health care system 

Examples of health care fraud include billing for a service that was never performed; a more expensive service, supplies or equipment other than what was really provided; or 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 lists 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? 
  
• Does the document show anything related to my health condition?
  
• Is the account I used to pay for care listed?
  
• Is my name on the document? 
  

Helpful Hints

Here are tips to avoid fraud and scams: 

• Never loan your member ID card to someone else.
  
• If your BCBSMT member ID or Social Security cards are lost or stolen – report it immediately. 
  
• Never share your information if medical services or equipment are offered to you free.
  

If you suspect fraud, BCBSMT offers the following ways to report it:

• Turn in a fraud report online 

• Call the customer service number on your member ID card. Or call 1-877-361-7594.  

• Email: privacy_office@bcbsmt.com

• By U.S. Mail: 
  Privacy Office 
  Blue Cross and Blue Shield of Montana 
  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 a scheme (or attempting) 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
  

BCBSMT’s credit monitoring is a basic service to our members. You are alerted when we notice suspicious activity on your credit reports.

We strive to help combat privacy and security violations. We offer identity protection services from leading identity protection services companies to eligible BCBS members on an opt-in basis, 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 and 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 you are who you say you –while using your mobile device or computer. 
  
• Can only be used once.