Materiales e información para asegurados

Usted puede conocer más sobre:

  • Qué esperar como nuevo asegurado
  • Su derecho a proteger sus necesidades y a entender la información y la atención que recibe
  • Su responsabilidad de brindar a sus proveedores la información que necesitan para cuidarlo a usted o a sus hijos
  • Cómo presentar una queja
  • Cómo reportar fraude de cuidados de salud

Comité asesor comunitario

¡Cuéntenos lo que piensa! Cada trimestre, Blue Cross and Blue Shield of Texas (BCBSTX) organiza una reunión del grupo asesor de asegurados (MAG) a fin de que podamos averiguar cómo podemos mejorar nuestros servicios. Si desea compartir sus ideas con el personal de BCBSTX y los socios comunitarios respecto a lo que le gusta acerca de los beneficios de su cobertura o los aspectos que podemos mejorar, llame gratis al especialista en Servicio al Cliente de CHIP de BCBSTX al 1-877-375-9097; TTY al 7-1-1.
Buscar una reunión del Comité asesor comunitario Documento PDF.

Glosario

Here are some terms you may see on this website or in your member handbook:

  • Apelación

    A request for your managed care organization to review a denial or a grievance again.

  • Complaint

    A grievance that you communicate to your health insurer or plan.

  • Copayment (Copago)

    A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

  • Equipos médicos duraderos (DME)

    Equipment ordered by a health care provider for everyday or extended use. Coverage for DME may include but is not limited to: oxygen equipment, wheelchairs, crutches, or diabetic supplies.

  • Emergency Medical Condition

    An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid harm.

  • Emergency Medical Transportation

    Ground or air ambulance services for an emergency medical condition.

  • Emergency Room Care

    Emergency services you get in an emergency room.

  • Servicios de emergencia

    Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.

  • Excluded Services

    Health care services that your health insurance or plan doesn’t pay for or cover.

  • Inconformidad

    A complaint to your health insurer or plan.

  • Habilitation Services and Devices

    Health care services such as physical or occupational therapy that help a person keep, learn, or improve skills and functioning for daily living.

  • Seguro de gastos médicos

    A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.

  • Cuidados de salud en el hogar

    Health care services a person receives in a home.

  • Atención médica para pacientes terminales

    Services to provide comfort and support for persons in the last stages of a terminal illness and their families.

  • Hospitalización

    Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.

  • Hospital Outpatient Care

    Care in a hospital that usually doesn’t require an overnight stay.

  • Medically Necessary

    Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.

  • Red

    The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.

  • Non-participating Provider

    A provider who doesn't have a contract with your health insurer or plan to provide covered services to you. It may be more difficult to obtain authorization from your health insurer or plan to obtain services from a non-participating provider instead of a participating provider. In limited cases, such as when there are no other providers, your health insurer can contract to pay a non-participating provider.

  • Proveedor participante

    A Provider who has a contract with your health insurer or plan to provide covered services to you.

  • Physician Services

    Health-care services a licensed medical physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) provides or coordinates.

  • Cobertura

    A benefit, like Medicaid, which provides and pays for your health-care services.

  • Autorización previa para servicios de salud 

    A decision by your health insurer or plan that a health-care service, treatment plan, prescription drug, or durable medical equipment that you or your provider has requested, is medically necessary. This decision or approval, sometimes called prior authorization, prior approval, or pre-certification, must be obtained prior to receiving the requested service. Pre-authorization isn't a promise your health insurance or plan will cover the cost.

  • Prima

    The amount that must be paid for your health insurance or plan.

  • Cobertura de medicamentos con receta

    Health insurance or plan that helps pay for prescription drugs and medications.

  • Medicamentos con receta

    Drugs and medications that by law require a prescription.

  • Médico de cabecera

    A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health-care services for a patient.

  • Médico de cabecera

    A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates, or helps a patient access a range of health-care services.

  • Proveedor

    A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine), health-care professional, or health-care facility licensed, certified, or accredited as required by state law.

  • Rehabilitation Services and Devices

    Health-care services such as physical or occupational therapy that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled.

  • Skilled Nursing Care

    Services from licensed nurses in your own home or in a nursing home.

  • Especialista

    A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.

  • Atención médica inmediata

    Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.

Si tiene preguntas, llame sin cargo al Servicio al Cliente al 1-888-657-6061 (TTY 7-1-1).

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