Welcome

 
 
 
Below is a list of frequently asked questions (FAQs) about BlueCHiP.
Please click the question link to read the answer.
BlueCHiP FAQs - Physician/Provider
 
How do I know what my copay should be?
How can I receive services from non-participating providers?
What are the requirements for a pre-authorization?
How can I tell if my new doctor accepts reimbursement from BlueCHiP?
I have a complaint about my doctor. Who can I talk to about this?
Can I obtain a Provider Directory?
 
Back to BlueCHiP FAQ Menu
 

How do I know what my copay should be?

Copayments vary by plan. You may also have different copayments for different types of services. For more information regarding your copayments, please contact BlueCHiP Customer Service at the numbers below:

BlueCHiP Commercial members:
(401) 274-3500 or 1-800-564-0888
 

Can I receive services from non-participating providers?

The Flex Rider allows you to receive services from non-participating providers and is offered to most BlueCHiP benefit packages (Except BlueCHiP for Medicare and BlueCHiP for RIte Care). The Flex Rider allows members to receive services from non-participating providers or from network providers without a referral from a primary care physician (PCP). For services to be reimbursed under the Flex Rider, members must meet their Flex deductible, the services must be medically necessary, and the services must be a covered benefit.

Members who have BlueCHip for Medicare or BlueCHiP for RIte Care are not eligible.

If you would like specific information regarding the Flex Rider, please contact BlueCHiP Customer Service at the numbers below:

BlueCHiP Commercial members:
(401) 274-3500 or 1-800-564-0888
 

What are the requirements for a pre-authorization?

Certain procedures require prior authorization. If you seek services from a participating physician or provider they will obtain authorization for you. If you seek services from an out of network provider you need to contact BlueCHiP for prior authorization. For more information regarding the pre-authorization process please contact BlueCHiP Customer Service at the numbers below:

BlueCHiP Commercial members:
(401) 274-3500 or 1-800-564-0888
 

How can I tell if my new doctor accepts reimbursement from BlueCHiP?

To find out whether a provider accepts reimbursementfrom BlueCHiP, check the Provider Directory you received with your benefit package. If you do not have a Provider Directory please contact BlueCHiP Customer Service at the numbers below:

BlueCHiP Commercial members:
(401) 274-3500 or 1-800-564-0888
 

I have a complaint about my doctor. Who can I talk to about this?

A complaint can be an oral or written expression of dissatisfaction from a member or a member's beneficiary, legal representative, parent, designated advocate/representative, or legal guardian.

Complaints may concern many issues, such as:
  • Premium increases

  • Complaints regarding response time (delay in claims processing)

  • Membership issues

  • Policy/network changes

  • Quality of care

Contact the Customer Service Department at the numbers below:

BlueCHiP Commercial members:
(401) 274-3500 or 1-800-564-0888


Hours:
Monday - Friday 8:15 a.m. - 7:00 p.m.
Saturday 9:00 a.m. - 2:00 p.m.

Please have the following information ready when you call:
  • Your 13 digit Identification number, name, date of birth, and Social Security number

  • Phone number

  • Date of service

  • Provider's Location (e.g., if the complaint is about a pharmacy, specify the location)

  • Provider's name

  • Nature of the complaint (brief summary)

Our customer service staff will attempt to resolve the issue with you. If you are still not satisfied after the discussion, the representative may initiate a complaint on your behalf or you may file a written complaint.

To file a written complaint, send a letter to the address below:

Grievance & Appeals Department
Blue Cross & Blue Shield of Rhode Island
15 LaSalle Square
Providence, RI 02903-3279

Include the following information in your letter:
  • Your 13 digit identification number, name, date of birth, and Social Security number

  • Phone number

  • Date of service

  • Provider's Location (e.g., if the complaint is about a pharmacy, specify the location)

  • Provider's name

  • Nature of the complaint (brief summary)
 

Can I obtain a Provider Directory?

Yes, you may obtain a Provider Directory by contacting BlueCHiP Customer Service:

BlueCHiP Commercial members:
(401) 274-3500 or 1-800-564-0888




Call or E-mail our Customer Service Center.