Reminder: Blue Cross doesn’t reimburse claims for experimental, investigational or medically unnecessary services

We’d like to remind you that Blue Cross Blue Shield of Michigan’s payment policy excludes reimbursement for experimental, investigational or medically unnecessary procedures, treatments, drugs or devices. This payment policy applies to all claims reported for Blue Cross Blue Shield of Michigan commercial contracts, including the BlueCard^® program.

Health care providers may not bill members for such services unless, prior to the services, all of these requirements are met:

1. You provide the member with a cost estimate of the service.
2. You have the member confirm in writing that he or she assumes financial responsibility for the service.
3. The member understands that Blue Cross won’t reimburse the provider for the service.

BlueCard claims for services that Blue Cross Blue Shield of Michigan reimburses, based on our payment policy, but that are denied by the member’s out-of-state home plan as experimental, investigational or medically unnecessary, according to the member’s contracted benefits, may be the member’s financial responsibility.