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July 2015
Blue Cross updates its concierge medicine policy
Health care providers must comply with affiliation agreements
As a reminder, Blue Cross Blue Shield of Michigan affiliation agreements require providers to:
- Submit claims for covered services (i.e., services covered under a member’s benefit plan) directly to Blue Cross.
- Accept our payment for covered services as payment in full.
- Only charge the member the applicable copay or deductible (or both) for the covered service.
- Not discriminate against members based on payment level, benefit or reimbursement policies.
Blue Cross Blue Shield of Michigan has made some changes to its concierge medicine policy since we wrote about it in a July 2014 Record article.
In a concierge, or “retainer,” practice, patients pay membership fees to a health care provider or third-party vender for enhanced services or amenities. As a benefit of paying this fee, members typically receive:
- Easy appointment access
- Extended office visits
- Enhanced email and telephone communication with doctors
- Care coordination (including referrals) between the concierge practice and specialists
- Wellness programs and plans, genetic and nutritional counseling, risk appraisals
Health care practitioners who wish to use this model in their practice must ensure that its requirements are permitted by their affiliation agreements with Blue Cross. Providers may charge a concierge fee if:
- Patients are not required to pay the concierge fee to become or continue to be a patient in the practice
- Patients are not required to pay the concierge fee to obtain access to the provider and are only permitted access to ancillary providers, such as physician assistants or nurse practitioners, if they do not pay the concierge fee
- The services or products being offered as part of the concierge fee are not considered “covered services” under our affiliation agreements, but instead are not covered under a member’s benefit plan. Because benefit structures vary significantly among our members, providers are expected to understand each member’s benefit structure to ensure that covered services are not included in the concierge fee.
- Patients who don’t pay the concierge fee continue to receive the same level of access and services as they previously received.
- Providers continue to meet Blue Cross and Blue Care Network performance standards regarding access and service.
- The concierge level of service is clearly over and above usual practice in Michigan. Complaints from members who experience a decline in service level may result in Blue Cross concluding that the practice is noncompliant with the nondiscrimination clause of our affiliation agreements.
If you have any questions about the concierge medicine policy or need clarification, contact your provider consultant. |
