Billing BCBSTX Members Additional Fees
There are limits on the additional fees you can charge Blue Cross and Blue Shield of Texas (BCBSTX) members when you are a participating network provider.
When you provide concierge services, these additional fees may be permissible. However, please consider the following when collecting extra amounts from BCBSTX members:
- For covered services, the only fees you can collect are copayments, coinsurance and/or deductibles. This means you can’t collect “concierge” or any other access fees as a condition of care.
- For services non-covered under our benefit plans, you must inform our members in writing of any additional fees, including concierge fees. They must agree to those fees in writing before the services occur.
- Services denied for payment based on bundling or other claim edits cannot be billed to the member even if the member has agreed in writing to be responsible for non-covered services.
As a participating provider, you may not treat our members differently based on whether they pay concierge fees. Members who do not pay extra fees should receive the same access to appointments, after-hours coverage and quality care as those who do pay the fees.
Note: Some health benefit plans (e.g., Health Savings Accounts) may be subject to Internal Revenue Service regulations for covered expenses.
Before rendering care, please check eligibility and benefits using Availity® or your preferred vendor to determine coverage and preauthorization requirements. Refer to the Eligibility and Benefits page on the BCBSTX provider website for more information on Availity.
Also, refer to Section B of the Provider Manuals on the provider website for information regarding additional fees.
If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.
Availity® is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.