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67 11/2005
Quality of Care/Quality of Service Issues
Quality of care/Quality of service issues relate to the delivery of care and/or
services by contracted network providers in ways that do not meet member
expectations. Examples of these types of issues are listed below:
• Dissatisfaction with a provider's services/treatment
• Dissatisfaction with a procedural outcome
• Dissatisfaction with access to care
• Provider or office staff rudeness
• Dissatisfaction with lack of physician availability
• Unprofessional behavior by a provider
• Member is unable to obtain a referral
• Incorrect or missed diagnoses
Members should address any Quality of care/Quality of service issues in writing
via fax to 1-877-868-7950 or by mail to:
Customer Care
Blue Cross and Blue Shield of Georgia, Inc.
P.O. Box 9907
Columbus, Georgia 31908
Should a Quality of care/Quality of services concern be voiced by a BCBSGa/BCBSHP
member who indicates involvement by you or your staff, BCBSGa will request your
help in bringing closure to the investigation if applicable. Please be assured that any
communication, in writing or by telephone, will be kept confidential.
Administrative Issues
Administrative issues are those which deal with the member's interaction with the
operations of Blue Cross and Blue Shield of Georgia. Those issues include untimely
payment of claims, inaccurate payment of claims, BCBSGa/BCBSHP providers billing
for services when precluded from doing so by contract, etc.