Past Issues

Health Options promotes open and free communication between providers and patients. Both physicians and members benefit when members understand all treatment alternatives available to them. Therefore, providers are encouraged to discuss all treatment options with their patients, whether or not the service or treatment is a covered benefit.

We congratulate physicians and other providers who maintain well-documented medical records. Accurate documentation facilitates communication, coordination and continuity of care for our members.

Health Options has accepted and approved standards established by the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services for accessibility services for its HMO members.

Blue Cross and Blue Shield of Florida, Inc. and its HMO subsidiary, Health Options Inc., respect the privacy of our members and have policies and procedures in accordance with the Privacy Rule to safeguard personal information in all forms – spoken, written and electronic.

Health Options is committed to providing quality health care coverage as well as maintaining the dignity and integrity of our members. Recognizing that service providers are independent contractors and not the agents of Health Options, we have adopted the member rights and responsibilities below.

The types of treatments, devices and drugs covered by Health Options are extensive. In light of the rapid changes in medical technology, it is important to continually look at new medical advances and technology to determine which will be covered by our health plan.

Blue Cross and Blue Shield of Florida and Health Options share a concern about the safety of its members and support practitioners and providers in the endeavor to continually improve patient safety.

Physicians can review denial criteria Health Options treating physicians have the opportunity to discuss any adverse determination based on medical appropriateness or necessity with the physician reviewer making the decision. An explanation of this procedure is included with each written adverse benefit determination notice. Providers may request and receive, free of charge, an explanation of the scientific or clinical criteria Health Options, Inc. relied upon in making an adverse benefit determination.

In our effort to continuously improve the health status of our members, we have adopted nationally recognized guidelines for preventive services and disease management.

Health Options has established a process for reviewing a member’s complaints and grievances/appeals. The purpose of this process is to facilitate review of, among other things, a member’s dissatisfaction with Health Options, its administrative practices, coverage, benefit or payment decisions, or with the administrative practices and/or the quality of care of any of the independent contracting health care providers in the Health Options provider network.

We are commited to quality care and service. Blue Cross and Blue Shield of Florida (BCBSF) and our HMO subsidiary, Health Options, fully support the standards established by regulatory agencies and the National Committee on Quality Assurance (NCQA).

As 2003 draws to a close, Blue Cross and Blue Shield of Florida wishes to take this opportunity to thank you for the important role you play in the lives of our members. We value your role and the relationship we have with you.