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Anti-Fraud

Fraud and Abuse Tip Referral Form

Please complete this form if you believe that fraud and/or abuse may have occured to you, a family member, or a coworker. Any individual, entity, or group that is employed by or provides a service on behalf of Independence Blue Cross (including employees, subscribers, professional providers, employees of a provider, facilities, or billing companies) may be the subject of the complaint.

The form will be forwarded to the Corporate and Financial Investigations Department for review/evaluation. You will receive a response to your complaint, unless you choose to remain anonymous.

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Referrer's Information
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Independence complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Independence does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. View our documentation for more information and to request language assistance services.

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To ensure your privacy, all information will be sent via a secure connection. Independence Blue Cross will not disclose any personal information to outside persons or entities unless we have written consent or unless authorized by law. Please see our Notice of Privacy Practices for more information.

To file an appeal or grievance for your medical benefit coverage or your prescription drug coverage, contact Keystone 65 Customer Service at 1-800-645-3965 or Personal Choice 65 Customer Service at 1-888-718-3333; TTY/TDD users should call 711, 7 days a week, 8 a.m. to 8 p.m.; or you can complete and submit online the Request for Medicare Prescription Drug Coverage Determination or the Request for Redetermination of Medicare Prescription Drug Denial.

For additional information from the Centers for Medicare and Medicaid Services (CMS) visit http://www.medicare.gov. If you prefer to file a grievance through CMS, please complete the Medicare Complaint Form. For additional assistance, visit The Office of the Medicare Ombudsman.

Independence Blue Cross offers Medicare Advantage plans with a Medicare contract. Enrollment in Independence Medicare Advantage plans depends on contract renewal.

Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association.

This information is not a complete description of benefits. Call 1-877-393-6733 (TTY/TDD: 711) for more information.

Keystone 65 HMO and Personal Choice 65SM PPO: For accommodation of persons with special needs at sales meetings call toll-free 1-877-393-6733 (711 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week. A sales person will be present with information and applications.

Select Option® PDP: For accommodation of persons with special needs at sales meetings call toll-free 1-888-678-7009 (711 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week. A sales person will be present with information and applications.

Every year, Medicare evaluates plans based on a 5-star rating system.

MedigapSecurity plans are offered through Independence Blue Cross and Highmark Blue Shield, independent licensees of the Blue Cross and Blue Shield Association. MedigapSecurity is not connected with or endorsed by the U.S. government or the federal Medicare program. To join, you must be enrolled in Medicare Parts A and B. Plan F and Plan N are available only to applicants who enroll within six months following enrollment in Medicare Part B or who are guaranteed the right to purchase these plans under applicable federal or state laws. You must continue to pay Medicare Part A (if applicable) and Part B premiums.

The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. ©2018. All rights reserved.

TruHearing® is a registered trademark of TruHearing, Inc., an independent company.

FutureScripts® is an independent company that provides pharmacy benefit management services.

Out-of-network/non-contracted providers are under no obligation to treat Independence Blue Cross Medicare members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Website last updated: 10/1/2018
Y0041_HM_19_67199 Accepted 10/1/2018