Important Information
We want you to have the best experience possible when you interact with our company, whether in person, on the phone or through our website. This section connects you to important information you may find helpful regarding your health insurance coverage with BCBSWY.
HIPAA Compliance
Blue Cross Blue Shield of Wyoming (BCBSWY) is complying with each of the HIPAA regulation standards by their respective mandated implementation dates.
BCBSWY has implemented the standard transactions and code sets regulations and has implemented policies and procedures to adhere to the privacy regulations. BCBSWY implemented security procedures to comply with HIPAA security requirements in April 2005. Activities surrounding these standards included:
- Hired a Systems Security and Privacy Officer who is responsible to ensure the development, implementation and management of BCBSWY security initiatives.
- Implemented HIPAA Privacy standards on April 14, 2003.
- Developed policies and procedures to comply with HIPAA security standards in April 2005.
- Trained staff on privacy and security policies as developed
Healthcare Fraud
Approximately 10 percent of our nation’s healthcare expenses are attributed to healthcare fraud. We need your help in controlling fraud and the expense it creates. We encourage you to report conduct that may be fraudulent. Some examples include:
Provider Fraud
- Billing for services not rendered
- Billing for additional, unnecessary treatment
- Billing for services outside of licensure scope
- Billing for services misrepresented
Policyholder Fraud
- Altered or falsified claims
- Letting someone else use ID card
- Trying to add ineligible person to contract
- Special requests for mailing of checks and EOBs
Insurance Fraud
How can you help?
If you suspect a problem, you can report it to us by calling (800) 442-2376 or (307) 634-1393 in Cheyenne.
You may also mail it to us at
Blue Cross Blue Shield of Wyoming
Attn: Fraud Reporting
PO Box 2266, Cheyenne WY 82003
Confidentiality
Every effort will be made to protect the identity of the reporting party. There will be no retaliation for good faith reporting.
Additional Assistance
For your convenience, we have provided the following information on our website.
- Translation services & special needs such as cognitive or physical impairments
- Finding a provider in our network
- A description of our participating provider basic compensation arrangement
- The maximum amount Blue Cross Blue Shield of Wyoming will reimburse for Covered Services under this Agreement. The Maximum Allowable Amount is the lesser of (1) the Healthcare Provider’s billed charges for the Covered Service, or (2) the maximum reimbursement rate Blue Cross Blue Shield of Wyoming has negotiated with its Participating Providers for the Covered Service as determined by the Blue Cross Blue Shield of Wyoming payment system in effect at the time the Covered Services are provided.
- Tools to assist with self-managing care, such as online wellness resources
- Consumer satisfaction information
- Blue Cross Blue Shield of Wyoming (BCBSWY) conducts surveys to collect information about consumers’ experience with BCBSWY and the services we provide. Consumer satisfaction information is available upon request.
- Product options, application and/or necessary paperwork to enroll in a plan
- Medical management requirements
- How the health benefits program works
- Member’s potential financial responsibilities, including out-of-pocket costs (deductibles, copays, coinsurance, annual and lifetime coinsurance limits) and changes that could occur during the enrollment period.
- Health benefits decision-making responsibilities for members, including generic vs. brand drug and in-network vs. out-of-network services
- Condition-specific criteria for benefits including any benefits provisions that affect a specific health condition
- Coordination of benefits
- Compliance with regulatory healthcare requirements, PPACA, which includes mental health parity
- Plan coverage including any exclusions and limitations