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New Blue Cross Plan Has Consumers Pay, Wait For Reimbursement

A new Blue Cross Blue Shield plan being offered on North Carolina’s exchange for 2019 will save consumers between 30 and 33 percent on their monthly premiums, but it comes with an important and costly caveat: it has no provider network, meaning all doctors and hospitals will be treated as out-of-network and can charge consumers whatever they want.

Instead, the high-deductible plan is eligible for a Health Savings Account (HSA), the Winston Salem Journal reports. Consumers can go to any provider they choose but are responsible for their medical bills and must wait for reimbursement.

MyChoice reimburses customers directly for medical procedures at rates that are up to 40 percent higher than what the doctor or hospital would receive for providing the exact same services to a patient on Medicare.

Consumers must be wary of their providers’ charges. If their provider charges over the plan’s cap, they could be stuck footing the bill.

If a provider charges more than 140 percent of the Medicare rate for a particular service, including emergency care, the member may be billed the difference by the provider and will be responsible for paying the balance owed.

“While approved claims go toward satisfying deductibles and out-of-pocket maxes, balance billing does not count toward the plan’s deductible or out of pocket max,” Blue Cross said.

The N.C. Healthcare Association warned consumers against Blue Cross Blue Shield’s newest plan.

“[W]e support expanded access and affordable insurance coverage options for North Carolinians ... unfortunately, this new product appears to be more of a financing tool than health insurance coverage… It puts all the responsibility on the customer to manage and pay their medical bills, in addition to their premiums before and after the high deductible is met.”


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