Frequently Asked Questions

Last Updated on September 20, 2024

We are working hard to keep you up to date on the latest information. Below are answers to your most commonly asked questions. This page will be updated frequently, so please check back for more information. Some of the terms we’ve used below may not be familiar. We’ve compiled a glossary of terms to help explain what each of the elements means.

The Situation

Vanderbilt Health facilities and affiliated providers will only be considered out-of-network for the Medicare Advantage plans in the BlueAdvantage (PPO) network beginning Jan. 1, 2025. This is a mutual decision between BlueCross and Vanderbilt Health, and it doesn’t impact any other BlueCross networks.

Click here to view the list of out of network facilities for our Medicare Advantage plan.

BCBST and Vanderbilt Health mutually decided to end the BlueAdvantage (PPO) contract, and it’s important to note this decision doesn’t affect any other BlueCross networks. We’re thankful for the many years of care Vanderbilt Health has offered our Medicare Advantage members through the BlueAdvantage (PPO) network. However, Vanderbilt Health facilities and providers will leave our BlueAdvantage (PPO) network on Jan. 1, 2025. 

We understand that many of our Medicare Advantage members with BlueAdvantage (PPO) coverage appreciate having Vanderbilt facilities and providers in their network. That’s why we’re sharing this news now, so that members have plenty of time to consider their plan options during this year’s Annual Enrollment Period. If you prefer to stay with BlueCross, we’ll work with you to find a new provider or network that works best for you.

Your Care

If you are a Medicare Advantage member with BlueAdvantage (PPO) coverage, Vanderbilt Health facilities and providers will be out-of-network for you after Dec. 31, 2024, and you'll need to seek care from another provider. The only exception is transplant care — all other forms of care will be considered out-of-network.

If you're a member of a different BlueCross BlueShield of Tennessee plan, this doesn’t impact you — you can continue to get care at Vanderbilt facilities. Vanderbilt remains in-network for all other BlueCross plans.

Vanderbilt Health facilities and affiliated providers will leave our BlueAdvantage (PPO) Network effective Jan. 1, 2025. If you’re a Medicare Advantage member with BlueAdvantage (PPO) coverage, you’ll need to seek care from another provider.

We're committed to coordinating care for our BlueAdvantage members and helping them get the services they need. Call the Member Service number on the back of your Member ID card or visit bcbst.com for help finding alternative care options.

Our 2024 Medicare Advantage plans include generous out-of-network benefits to help keep your costs low. This means that, as long as CHI Memorial agrees to see you, you could continue seeing your preferred CHI Memorial-affiliated providers with limited cost differences.

To see the out-of-network benefits included in your plan, look at your Evidence of Coverage (EOC) here. You can find your BlueAdvantage plan on the middle left side of your Member ID card so you know which EOC to review.

Yes, you should always go to the closest hospital of your choice in a true emergency. Emergency room benefits for true emergencies won’t be affected after Vanderbilt Health leaves our Medicare Advantage BlueAdvantage (PPO) network on Jan 1, 2025. Our plans cover emergency room benefits for true emergencies as in-network. Please note that, if admitted and once stabilized, you will need to be transferred to an in-network facility. See below for the definition of a true emergency.

An emergency is defined as a sudden and unexpected medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect to result in:

serious impairment of bodily functions; or
serious dysfunction of any bodily organ or part; or
placing a person’s health in serious jeopardy.
Examples of emergency conditions include: (1) severe chest pain (2) uncontrollable bleeding and (3) unconsciousness.

Doctors and Health Facilities

Scheduled Procedures/Ongoing Treatment

Vanderbilt Health remains in our BlueAdvantage (PPO) network through Dec. 31, 2024. Any authorized and scheduled surgeries between now and then will be covered as in-network. As of Jan. 1, 2025, Vanderbilt Health facilities and affiliated providers will be considered out-of-network and you’ll need to seek care from another provider.

However, this does not include transplants. Medicare Advantage members with a BlueAdvantage (PPO) plan will still be able to receive transplant care from Vanderbilt facilities and providers after this date.

If you are a Medicare Advantage member with a BlueAdvantage (PPO) plan and you have ongoing services scheduled at a Vanderbilt Health facility, a nurse from BlueCross will work with you and help make sure you continue to receive appropriate care from an in-network health care provider. Our goal is to ensure you experience no disruptions in care.

Under our Continuity of Care policy, some Vanderbilt Health patients with BlueAdvantage coverage may be granted in-network status. Patients who may qualify for this status include:

Patients whose practitioner/facility are terminated from the network during treatment, i.e., chemotherapy or radiation patients; and

Patients with complex medical and/or behavioral health conditions.

If you think you qualify for in-network status, please call us at 1-888-770-8840 or complete this form and return it to: BlueCross BlueShield of Tennessee, 1 Cameron Hill Circle, Ste. 0002, Chattanooga, TN 37402-0002.