Availability of the services described in this article may vary by plan.
We know you may have questions about your medical condition and how best to coordinate your care. Having access to utilization management (UM) staff can help you better understand your options.
Utilization management (UM) is a tool that helps Blue Cross and Blue Shield of Texas (BCBSTX) determine whether you are getting appropriate care. UM decisions are based on medical need. That includes whether your care, services and benefits are right for you.
BCBSTX provides access to staff for members who want information about the UM process and the authorization of care. These services are provided for members:
- Staff are available at least eight hours a day during normal business hours for inbound collect or toll-free calls about UM issues.
- Staff can receive inbound telephone, e-mail, and fax communications about UM issues. Communications received after normal business hours are returned on the next business day. Those received after midnight on Monday through Thursday are responded to on the same business day. Those received after midnight on Friday are responded to on Monday except for regularly scheduled national holidays. In that case, calls are returned the next business day.
- Staff give their names, titles and organization name when making or returning calls about UM matters.
- TDD/TTY services are used when a member has hearing or speech difficulties.
- For members who need language translation, the service is provided free of charge in the requested language through bilingual staff or an interpreter during business hours. Language assistance is not applicable if BCBSTX does not make UM decisions and all services are automatically approved.
The more information you have about your medical care, the better you can manage your care. Using the resources available to you can help.
If you have questions, call the toll-free customer service number on the back of your member ID card.