BlueCross BlueShield Update - Jan 2024

Please watch this video first…

 

If you a have MEDICARE with BlueCross BlueShield, or BlueCross BlueShield PPO alone, we ARE still able to treat you!

We can bill you either IN-NETWORK, OUT-OF-NETWORK, or as a CASH client - depending on your plan. (details below).

To understand our new policies for each plan, please click on the link below that applies to you:

1 - BlueCross MEDICARE ADVANTAGE

2 - MEDICARE as your Primary Insurance + BlueCross BlueShield as your Secondary Insurance

3 - ONLY BlueCross BlueShield PPO or Florida Blue PPO


Still have questions after clicking the links above? Please click here to visit the FAQ section below

 

1 - BlueCross Medicare Advantage

If you have this plan you should have two cards: A red, white, and blue MEDICARE HEALTH INSURANCE card AND a BCBS Medicare ADVANTAGE card. If you do, then you have a BlueCross Medicare ADVANTAGE plan. 

To identify if you have this plan, Look for the word ADVANTAGE on your BCBS card:

 

OUR NEW POLICY
BCBS ADVANTAGE

Unfortunately, we are NOT able to accept this insurance plan IN-NETWORK. However, this plan DOES have OUT-OF-NETWORK benefits that can still be utilized at our clinic.

Your out-of-network benefits may cover a significant portion of the costs, ensuring that the overall financial impact on you is minimal.

HOW IT WORKS

For this plan, if you have a copay with your plan, you will pay us your copay at the time of your office visit. Be aware that your copays may be as much as double as they were before - it all depends on your plan.

After your visit, we will bill your insurance, and you may or may not receive a bill from us for your coinsurance or deductible, depending on your particular plan.

We recommend consulting your insurance provider for details about your OUT-OF-NETWORK benefits and fees. There is no CASH option with this plan.

NOTE - You will NOT use or need the red, white, and blue MEDICARE HEALTH INSURANCE card when you visit us. Instead, from now on, you will ONLY use your Medicare ADVANTAGE card, because this is now your Primary health insurance plan.

 

2 - Medicare as your Primary Insurance + BlueCross BlueShield as your Secondary Insurance

With this plan, you should have two cards: A MEDICARE HEALTH INSURANCE card AND a BlueCross BlueShield PPO card. MEDICARE is your Primary Insurance + BlueCross BlueShield is your SECONDARY or SUPPLEMENTAL.

To identify if you have this plan, look for PPO on your insurance card. (It should NOT have the word ADVANTAGE on your card. If you see ADVANTAGE, then you have an ADVANTAGE plan. Scroll up for details about that plan)

 

OUR NEW POLICY
MEDICARE + BCBS

Nothing has changed for you - we are still IN-NETWORK with this plan. We can bill you the same as we always have.

We are able to bill MEDICARE as the primary insurance for 80%, and the BCBS PPO secondary does pay us the remaining 20% even though we are not contracted with them.

 
 
 

3 - ONLY BlueCross BlueShield PPO or Florida Blue PPO

With this plan you ONLY have ONE BlueCross BlueShield PPO OR a Florida Blue PPO health insurance card…(i.e. You are under age 65, and you do NOT have Medicare).

You have BlueCross BlueShield PPO or a Florida Blue PPO as your only insurance plan. Your card may look like one of the following - (look for PPO on your card):

OUR NEW POLICY
BCBS PPO ONLY

As of Jan 1, 2024, we will no longer be accepting payment for these plans as an IN-NETWORK provider. HOWEVER, the good news is that we CAN still treat you, and you will have two options for payment moving forward:

1 - OUT-OF-NETWORK - Most patients with BCBS PPO or Florida Blue PPO have OUT-OF-NETWORK benefits that can still be utilized at our clinic. Your out-of-network benefits may cover a significant portion of the costs, ensuring that the overall financial impact on you is minimal.

HOW IT WORKS - For OUT-OF-NETWORK billing, if you have a copay, you will pay us your copay at the time of the visit (and your copay may be more than it was before).

We will also bill your insurance, and we will send you a bill for the balance. You will be responsible for paying us your coinsurance or deductible at that time.

Please check with your insurance company for details about your OUT-OF-NETWORK benefits and fees. If you need billing codes, please text Diann at:  239-323-5509.

2 - CASH - If your BCBS PPO or Florida Blue PPO plan does NOT have out-of-network benefits, or if you just prefer a cash option, you can pay cash for your visit. We have created a special cash-only price for you, to keep your expenses as low as possible. 

HOW IT WORKS - If you choose this CASH option, we will NOT run your visit through your insurance, and you’ll only need ONE visit - (with NO prior authorization needed for your procedure). You will simply pay the cash price at the time of your visit, and be done!

 

FAQ's

We know this can be confusing, so here are answers to some few Frequently Asked Questions…

  • You can check your out-of-network benefits by contacting BlueCross BlueShield directly or reviewing your insurance policy documentation.

  • Unfortunately, we are not able to provide that for you since every plan is different and we do not have access to any of that information.

    What we CAN do is provide the CPT codes for the specific procedure we are recommending for you, and with those codes your BCBS agent may be able to help you with an estimate.

    If you need these codes, please text us through our secure, HIPAA-compliant texting platform, Klara.

    Please click the purple “Message us” button in the lower right corner, or text Diann at: 239-323-5509.

  • Yes, for the insurance side of our practice (Interventional Specialist Center, LLC) we accept a variety of other insurance plans, including: Aetna PPO, Cigna PPO, Humana PPO, and Medicare.

    We are in-network with only PPO plans; we are still not participating with any HMO plans.

  • If you have out-of-network benefits, we will submit the claims.

  • Our dedicated team is here to assist you with any questions or concerns.

    If you have any more questions feel free to reach out to Diann, our Practice Manager, by contacting her through our secure, HIPAA-compliant texting platform, Klara.

    Please click the purple “Message us” button in the lower right corner, or text Diann at: 239-323-5509.