What happens to my coverage if I don’t pay my bill on time?

You pay in advance for your coverage.

You confirm your enrollment when you make your first payment. So it’s important that you pay your bill on time and in full. If you don’t, your plan could be canceled.

After making your first payment, you'll have a grace period if you don't pay your bill on time. You'll need to pay anything you owe by the time the grace period ends. If you don't, you could risk losing your coverage.

If your payment doesn’t go through or you don’t have enough money in your account to make the full payment, we’ll send you a letter to let you know. As soon as you know, call the customer service number on the back of your Blue Cross ID card. We’ll take your payment over the phone so you'll be able to use your coverage.

What happens to your claims

If you don’t pay your bill on time, you will enter a grace period. If we do not receive payment in full, you may have to pay for any health care services you received during your grace period. Unless your plan has been canceled, we’ll start your coverage back up as soon as we get your payment in full.

If you are not eligible for the Advanced Premium Tax Credit or you bought your coverage directly from us, your grace period is 31 days. During that time your claims will be pended.

If you’re eligible for the Advanced Premium Tax Credit, your claims will be processed differently than normal during a 90-day grace period.

  • During the first month, we will pay your claims normally.
  • During the second and third months, your claims will be pended. That means they’ll be held by us and will not be paid or denied. Any pharmacy claims will be rejected. You’ll need to pay out-of-pocket for them.
  • After three consecutive months without payment in full, you’ll be responsible for any pended claims.

A retroactive denial may occur after a service is performed and your provider has billed us for this service. Retroactive denials can occur when:

  • Claims are pended during the second and third month of a grace period and the member fails to pay their premium within the required timeline to continue coverage. The member will be held liable for the cost of services for claims rejected by the plan. 
  • Prior Authorization for a service is required but there has been no request for review (prior authorization) to determine medical necessity.
  • Services have been provided and the benefit has been exhausted.

Ways to prevent retroactive denials:

  • Be sure your premiums are paid on time. 
  • Ensure that your provider has submitted the necessary information in situations where a prior authorization is required. 
  • Be sure to know your benefits and do not use them without being sure your services are a benefit.

What happens to your coverage

If you wait too long to make your payment in full, we’ll cancel your coverage. When we cancel it depends on how you bought your plan.

  • If you bought your plan on the Health Insurance Marketplace at healthcare.gov and you’re eligible for the Advanced Premium Tax Credit, we’ll cancel after three months.
  • If you bought your plan on the Health Insurance Marketplace and you’re not eligible for the Advanced Premium Tax Credit, we’ll cancel after one month.
  • If you bought your plan directly from us and didn’t use healthcare.gov, we’ll cancel after one month.