Use of Groupon^® prohibited by terms of participation agreements

The terms of Blue Cross Blue Shield of Michigan’s participation agreements require providers to bill Blue Cross directly for all covered services provided to our members. Under these agreements, participating providers must accept BCBSM’s reimbursement as payment in full for covered services, except for applicable copayments and deductibles. The agreements require accurate cost-sharing amounts to be collected, and prohibit, except in certain limited situations, the waiving of member cost-sharing amounts.

That’s why accepting a Groupon as payment for a covered service violates the terms of the Blue Cross participation agreements. A Groupon is generally a discounted gift certificate usable at local or national companies. An example of a Groupon in a health care setting would be a provider offering services to be rendered for a flat dollar amount. Such a practice violates our participation agreements because it involves charging a member up front for services that the provider should be billing to Blue Cross for after the services are rendered.

More information about member eligibility, benefits and cost sharing is available through web-DENIS and PARS (formerly CAREN)**. Providers should check this information at each patient visit to determine the appropriate cost-sharing amounts.

**The Federal Employee Program^® won’t transition to PARS until 2015.