01/08/2025
Health care providers must file claims for any covered services rendered to a patient enrolled in a Blue Cross and Blue Shield of Texas health plan. You may collect the full amounts of any deductible, coinsurance, or copayment due and then file the claim with BCBSTX. Arrangements to offer cash discounts to an enrollee in lieu of filing claims with BCBSTX violate the requirements of your provider contract with BCBSTX.
The Health Insurance Portability and Accountability Act adds a requirement that if a patient self pays for a service in full and directs a provider to not file a claim with the patient's insurer, the provider must comply with that HIPAA directive and may not file the claim in question.