Saturday, 5 November 2016

Member Cost-sharing- Coinsurnace, copay

Deductibles, coinsurance and copayments are the member’s contribution toward all services. As a participating provider, you have agreed to not waive these amounts. When the charge for an office visit is less than the member’s copayment, providers should collect the actual charge. If you collect any amount above the copayment for covered services, you must refund the member the excess amount collected within 30 days of notification of the overpayment.

Participating providers have also pledged to assist us in our efforts to keep our members’ costs down. Please be aware that members could pay higher copayments for certain covered services performed by different types of providers and facilities. The chart below illustrates an example situation of how a member’s cost share will increase if they go to an outpatient facility for services that may be performed at an in-network physician’s office, in-network independent lab or free-standing diagnostic imaging facility:

Reimbursement Review

Blue Cross recognizes there may be times when participating providers disagree with the way a claim was adjudicated.

In those instances, providers may complete the Claims Dispute Form included in this manual. Our new Claims Dispute Form has replaced the Reimbursement Review Form. This form is available online now for use for when you have a claims dispute.

Effective June 1, 2016, we no longer accept the Reimbursement Review Form. Please be sure to complete the entire form and include any supporting documentation. Please return the form to Customer Service, P.O. Box 98029, Baton Rouge, LA 70898-9029.

Family Members Excluded

REMINDER: Any services rendered by a provider to a family member such as a spouse, child, stepchild, parent, stepparent or grandparent, etc. are excluded as services you may bill to Blue Cross.

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