FREQUENTLY ASKED QUESTIONS
Privacidad y seguridad
Get answers to common questions about privacy and security with Blue Cross and Blue Shield of New Mexico. Learn how we safeguard your information and how you can protect your data.
Absolutely. Since 1996, the Health Insurance Portability and Accountability Act (HIPAA) has helped protect your privacy.
Es la ley
Conforme a las leyes federales y estatales, BCBSNM debe enviar un Aviso de prácticas de privacidad a los asegurados de la cobertura. Este aviso explica cómo BCBSNM puede usar y compartir la información médica y financiera de un asegurado. 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.
Aviso de prácticas de seguridad de BCBSNM
Our Pledge to You
BCBSNM 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:
El centro móvil de atención (MAC, en inglés) de Code of Ethics and Conduct for our employees.
A Vendor Code of Ethics and Conduct para los proveedores que hacen negocios con nosotros o prestan servicios a nuestros clientes.
More Safeguards
In addition, BCBSNM has its own Special Investigations Department (SID) to fight fraud. El personal del SID incluye a personas de distintos orígenes, por ejemplo:
- Insurance industry experts.
- Law enforcement.
- Medical providers.
- Professional coders.
El SID también cuenta con una unidad de inteligencia de datos que trabaja junto con los investigadores del SID para investigar y detener casos de fraude, despilfarro y abuso. Cuando corresponde, SID deriva los casos de fraude para que sigan un proceso penal.
Health care fraud, waste and abuse has a negative affect on the health care industry and our nation. They cost billions of dollars each year. It 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 billing for a service that was never performed
- a provider billing for a more expensive service, supplies or equipment than what was really provided
- a provider rendering 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 list your private data:
- Dirección
- Birthdate
- Número de Seguro Social
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?
Consejos útiles
Here are tips to avoid fraud and scams:
- Never loan your member ID card to someone else.
- If your BCBSNM member 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, BCBSNM offers the following ways to report it:
En línea
Complete un reporte de fraude.
Teléfono
Call the customer service number on your member ID card or 1-877-361-7594.
Correo electrónico
Por correo
Privacy Office
Blue Cross and Blue Shield of New Mexico
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 (or attempting) 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.
What You Can Do
- Call our Provider Fraud Hotline at 1-800-543-0867 para informar sobre los casos de fraude en la atención médica.
- 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.
BCBSNM's credit monitoring alerts you when we notice suspicious activity on your credit reports. This helps 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 services companies to eligible BCBSNM members, where permitted by local regulation and subject to certain local market limitations. Esto incluye:
- 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. 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 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 proves you are who you say you are while using your mobile device or computer.
- Can only be used once.