Reminders: Our affiliation agreements and our concierge medicine policy

Health care providers must comply with their affiliation agreements. Blue Cross Blue Shield of Michigan affiliation agreements require providers to:

• Submit claims for covered services 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.
• Avoid discriminating against members based on payment level, benefit or reimbursement policies.

Concierge medicine policy

In a concierge practice, patients pay membership fees to a health care provider or third-party vendor 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

Policy information

Blue Cross’ concierge medicine policy states:

“Health care practitioners who wish to use this model in their practice may not be eligible for any value-based reimbursement (VBR) opportunities through Blue Cross and Blue Care Network (BCN) programs such as, but not limited to, Physician Group Incentive Program-related VBR opportunities through the Patient-Centered Medical Home (PCMH) designation program or other programs.”

Also, providers must ensure that the requirements of the concierge model are permitted by their affiliation agreements with Blue Cross.

Providers may charge a concierge fee if:

• Blue Cross and BCN members aren’t required to pay the concierge fee to become or continue to be a patient in the practice.
• Blue Cross and BCN members aren’t required to pay the concierge fee to obtain access to the provider. Blue Cross members who don’t pay the concierge fee may not be restricted to access only to ancillary providers, such as physician assistants or nurse practitioners. 
• The services or products being offered as part of the concierge fee aren’t considered “covered services” as defined under our affiliation agreements or the member’s benefit plan, or both. Because benefit structures vary significantly among our members, providers are expected to understand each member’s benefit structure to ensure that covered services aren’t included in the concierge fee.
• Blue Cross and BCN members 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 BCN 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.