Access to Care

After-Hours Access 
Centers for Medicare and Medicaid Services (CMS) requires that the hours of operation of its practitioners are convenient for and do not discriminate against members. 

Practitioners must provide coverage for their practice 24 hours a day, seven days a week with a published after-hours telephone number (to a practitioner’s home or other relevant location), pager or answering service, or a recorded message directing members to a physician for after-hours care instruction. Note: Recorded messages instructing members to obtain treatment via emergency room for conditions that are not life threatening are not acceptable.  

In addition, primary care physicians must provide appropriate backup for absences. 

Appointment Access
Primary Care and Behavioral Health practitioners must meet the following appointment standards for all Blue Cross and Blue Shield of Nebraska (BCBSNE) Medicare Advantage members. 

Appointment accessibility will be measured and monitored using the following standards.

Compliance with Access Standards 
BCBSNE has delegated the responsibility to assess and monitor compliance with the standards to its HMO Network. If it is determined that a practitioner does not meet access to care standards, the non-compliant practitioner must submit a corrective action plan within 30 days of notification.

BCBSNE encourages Medicare Advantage plan practitioners (or their office staff) to assist members whenever possible in finding an in-network practitioner who can provide necessary services. If assistance is needed in arranging for specialty care (in– or out-of-network), please call our Provider Inquiry department at 888-505-2022. 

BCBSNE network providers must ensure that all services, both clinical and non-clinical, are accessible to all members and are provided in a culturally competent manner, including those members with limited English proficiency or reading skills and those with diverse cultural and ethnic backgrounds. Providers and their office staff are not allowed to discriminate against members in the delivery of health care services consistent with benefits covered in their policy based on race, ethnicity, national origin, religion, sex, age, mental or physical disability or medical condition, such as end stage renal disease, sexual orientation, claims experience, medical history, evidence of insurability (including conditions arising out of acts of domestic violence), disability, genetic information, or source of payment. It is necessary that a provider’s office can demonstrate they accept for treatment any member in need of health care services they provide.