COMPLIANCE AND PRIVACY POLICIES
Our privacy commitment
At Blue Shield of California Promise Health Plan, we understand the importance of keeping your personal information private, and we take our obligation to do so very seriously.
In the normal course of doing business, we create records about you, your medical treatment, and the services we provide to you. The information in those records is called protected health information (PHI) and includes your name, address, telephone number, Social Security number, and your health information, such as healthcare diagnosis or claim information.
Federal and state law requires us to provide you with this notice of our legal duties and privacy practices as they relate to your PHI. We are required to maintain the privacy of your PHI and to notify you in the event that a breach of unsecured PHI affects you.
How we protect your privacy
We maintain physical, technical, and administrative safeguards to ensure the privacy of your PHI. To protect your privacy, only authorized and train Blue Shield of California Promise Health Plan employees have access to our paper and electronic records, and to non-public areas where this information is stored.
We have strict privacy and data protection policies and procedures, including how paper and electronic records are labeled, stored, filed, and accessed. Physical, technical, and administrative safeguards are in place to maintain your PHI privacy and security. Our corporate Privacy Office monitors how we follow our privacy policies and procedures and educates our organization on this important topic.
Use this form to authorize Blue Shield of California Promise Health Plan to use or to disclose your health information to another person or organization:
Healthcare fraud prevention and reporting
The purpose of this information is to increase your awareness of healthcare fraud, and to ask for your cooperation in reporting suspicious incidents to Blue Shield of California Promise Health Plan. Healthcare fraud costs the United States approximately $60 billion annually. That’s why it is important that everyone be aware of possible fraud and abuse and, report the incident as quickly as possible.
Whether it is an organized effort by a provider, member, or any other individual to deliberately cheat, or the action of an individual healthcare provider who occasionally bends the rules to serve the perceived needs of a patient, healthcare fraud is a serious and growing problem. It exploits patients and robs them of services and resources critical to their well-being.
By definition, fraud means that someone is trying to obtain something of value by intentionally deceiving, misrepresenting, or concealing. There are at least as many kinds of fraud as there are types of people who commit it, and fraud in the healthcare system is no exception. Examples of common types of healthcare fraud include:
- Provider fraud
- Billing for services not provided
- Billing of “free” services
- Incorrect reporting of diagnoses or procedures to maximize payments (known as unbundling, up-coding)
- Waiver of deductible and/or copayment
- Misrepresentation of dates or descriptions of services
- Billing non-covered services as covered items
- Subscriber/member fraud
- Loaning an ID card to someone else
- Altering amounts charged on claim forms or prescription receipts
- Filing false claims
- Non-subscriber/non-member fraud
- Using a stolen ID card to receive medical services
What to do if you suspect fraud
We urge all individuals to tell us when they suspect fraud. If at any time you suspect a fraudulent issue, please call or email us as soon as possible. All reported incidents are taken seriously. Each incident of fraud, uncovered and stopped, saves money for every consumer. And that is as important to you as it is to us.
Blue Shield of California Promise Health Plan Compliance Helpline phone: (800) 221-2367, 24 hours a day, 7 days a week
You may remain anonymous or include your contact information. The SIU reviews all reports and may contact you if they need additional information.
Acting with integrity
Blue Shield of California Promise Health Plan is an affiliated of Blue Shield of California and operates under the Blue Shield of California Code of Conduct. To learn more about how we conduct business, download the Blue Shield of California Code of Conduct (PDF, 1.9 MB)
Protecting your privacy
Learn more about medical identity theft, how to recognize it, how to protect yourself, how to report it, and find other fraud prevention resources:
Frequently asked questions
See questions our members ask most frequently about Blue Shield Promise Medi-Cal.
Member rights and responsibilities
Find out about your rights and responsibilities as a Blue Shield Promise Medi-Cal member.
Download the Member Handbook for your area in your preferred language.
Language assistance services
Blue Shield of California Promise Health Plan complies with State and Federal civil rights laws and provides free language services to people whose primary language is not English. We communicate with our members in many different languages and dialects including English, Spanish, Cantonese, Mandarin, Armenian, Russian, Vietnamese, Khmer (Cambodian), among others.