Privacy and Security

Absolutely. Since 1996, the Health Insurance Portability and Accountability Act (HIPAA) has helped protect your privacy. 

It’s the Law

BCBSTX is required by federal and state law to give a Privacy Practices Notice to plan members. The notice explains how we 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.

BCBSTX Privacy Practices Notice

Our Pledge to You

BCBSTX 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 provide services to our customers.

More Safeguards

BCBSTX has its own Special Investigations Department to fight fraud. The team includes people from diverse backgrounds. such as: 

• Insurance industry experts
• Law enforcement
• Medical providers
• Professional coders

SID also has a Data Intelligence Unit that partners with SID investigators to find and stop fraud, waste and abuse. When appropriate, fraud cases are referred for criminal prosecution.

Health care fraud, waste and abuse has a negative effect on the health care industry and our nation. Together, they cost billions of dollars each year and 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 who:

• Bills for a service that was never performed
• Bills for a more expensive service, supplies or equipment than they provided
• Renders the same service twice

Your Private Health Information

Aside from billing fraud, your PHI can be at risk. PHI consists of your medical records and other health-related documents that list your private: 

• 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 ID card to someone else.
• If your BCBSTX 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, BCBSTX offers the following ways to report it:

Online

Complete a fraud report .

Phone

Call a representative at 1-877-842-7562 or our Provider Fraud Hotline at  1-800-543-0867.  

Email

Mail

Privacy Office  
Blue Cross and Blue Shield of Texas  
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. 

Fraud is running or attempting to run 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.  

Help Us Stop Fraud

• Call our Provider Fraud Hotline at 1-800-543-0867 to report suspected health care fraud.
• Always keep your  ID card and health records in safe place.
• Ask providers to explain why a service is necessary. If in doubt, get a second opinion from another doctor. 
• Review and understand your Explanation of Benefit statements.
• Verify that you had exams, tests or treatments with the listed provider.
• Count your pills every time you pick up a prescription.

We strive to help combat privacy and security violations. As a BCBSTX member, you and your eligible family members have access to identity protection services, including credit monitoring, fraud detection and fraud resolution support. Enrolling in credit monitoring alerts helps you identify and stop a privacy or security breach before it happens. This is a basic service offered to all of our members on an opt-in basis.

To enroll:

• Log in to your online account.
• Go to Coverage and then Coverage and Benefits.
• Scroll down to Identity Protection then Learn more.
• Then Get Code.
• And Get started with adult enrollment or Get started with minor dependent enrollment.

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 verification code is a security method that’s used for a single log-in 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.

A one-time verification code:

• Delivers a computer-generated code delivered by email, text message 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.