Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.
- For covered services under BCBSTX benefit plans, you may collect only copayments, coinsurance, and deductibles; you can’t collect “concierge” or any other access fees as a condition of care.
- For noncovered services under these plans, you must inform your patients in writing of any additional fees, including concierge fees. Patients must agree to those fees in writing before they receive the services.
- You cannot bill a patient for services denied for payment because of bundling or other claim edits, even if the patient has agreed in writing to be responsible for noncovered services.
“As a participating provider, you may not treat our members differently based on whether they pay concierge fees,” BCBSTX said in a Feb. 20, 2019, announcement. “Members who do not pay extra fees should receive the same access to appointments, after-hours coverage, and care as those who do pay the fees.”
The Texas Medical Association’s payment specialists continuously review health care payment plans’ newsletters and updates for items important to Texas physicians. Texas Medicine Today periodically publishes key excerpts from those newsletters that you might have missed.
If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Reimbursement Review and Resolution Service (formerly known as the Hassle Factor Log program) to help resolve insurance-related problems. Visit www.texmed.org/GetPaid for more resources and information.
Last Updated On
September 23, 2020
Originally Published On
April 23, 2019