Privacy and Security FAQs

BCBSTX follows strict federal laws, business ethics and safeguards to protect your privacy. As a BCBSTX member, here’s what you can expect:

• You’ll always have the right to protect your private health information (PHI), like the right to request limits on what we can use and share, the right to choose someone to act for you, the right to file a complaint and more.
• BCBSTX employees and vendors will follow our core values of integrity, respect, commitment, excellence and caring to protect your information.
• Our Special Investigations Department (SID) is actively fighting against insurance fraud, waste, and abuse to protect you.

Since 1996, the Health Insurance Portability and Accountability Act (HIPAA) has helped protect your privacy and your health information. All insurers, including BCBSTX, follow HIPAA rules and requirements.

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 BCBSTX 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/or provide services to our customers.

More Safeguards

In addition, BCBSTX 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 are types of misuse of health care services and resources. They may be things that are done on purpose, like a doctor knowingly billing for the wrong service. Or they may be unintentional, like an automatic prescription being refilled when a patient no longer needs it.

Fraud, waste and abuse hurt the health care industry, our nation and your pocket. They cost billions of dollars each year. They could 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 doctor billing for a service that wasn’t performed.
• A health care office billing for more expensive services, supplies or equipment than you actually received.
• A provider charging for the same service twice.

Your Private Health Information (PHI)

In addition to billing fraud that cost you or the company money, health care fraud can put your PHI ar risk. PHI includes your medical records and other health-related documents that list your private data, like: 

• Address
• Birthdate
• Social Security number (SSN)

Helpful Hints

Here are tips to avoid fraud and scams: 

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

Read more about:

How to Protect Yourself From Health Coverage Scams

If a document doesn’t relate to your health, it might not be PHI – even if it still includes private information about you and your life. 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?

If you answered yes to these questions, the document is likely PHI. If you answered no, the document may not be PHI.

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

Online

Complete a fraud report.

Phone

Call the customer service number on your member ID. 

Email

privacy_office@BCBSTX.com

Mail

Privacy Office 
Blue Cross and Blue Shield of Texas 
300 E. Randolph St.  
Chicago, IL 60601-5099

Are you a Medicaid member? You may have a different reporting process. To get started, visit our Medicaid Fraud Reporting page.

Provider fraud, waste and abuse are specific types of misuse to watch out for. Provider misuse of health care services and resources is one part of general health care fraud, waste and abuse. This type is specific to the actions a doctor, hospital or other provider takes.

Providers are licensed health care facilities, programs, agencies, doctors or other professionals who deliver health care services. 

So, what’s the difference between fraud, waste and abuse?

• Fraud is intentionally using deception or misrepresenting facts to gain unauthorized benefit or payment. 
• Waste is causing unnecessary costs to the health care system by using more services than needed.
• Abuse is payment for goods or services to someone who is not entitled to it or providing services that aren’t medically necessary. 

BCBSTX is taking active steps to protect you and your information. You can help, too. Make sure to:

• Always keep your member ID card and health records in a safe place.
• Ask providers to explain why you need a test or service. If in doubt, get a second opinion from another doctor. 
• Review and understand your Explanation of Benefit (EOB) statements.
• When you get your EOB or review a claim, confirm the right provider, exams, tests and treatments are listed.
• Count your pills every time you pick up a prescription.

BCBSTXs credit monitoring alerts you when we notice suspicious activity on your credit reports. This may help 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 companies to eligible BCBSTX members, where permitted by law. This service includes:

• Credit monitoring – Monitors activity that may affect your 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 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 allows a user to log into a network or application. Its purpose is to minimize the risk of fraudulent access and maintain high security standards.

Specifically, a one-time passcode:

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