The goal of the Government Mandates is to break down barriers in the nation’s health system in an effort to provide members with improved access to their health information. The mandates also aim to prevent situations where members might incur unexpected costs.
Blue Cross and Blue Shield of Kansas City (Blue KC) is committed to complying with all requirements under the Consolidated Appropriations Act (CAA) and Transparency in Coverage Rule (TCR). As such, we have engaged project managers to drive the implementation work for each mandate to ensure compliance timelines and deliverables are met. Below is an overview of some key points associated with the CAA that we thought might be interesting to you:
- ID Card Deductible and Out of Pocket (OOP) Limitations: Blue KC will be adding the member’s major medical deductible and applicable medical out of pocket maximums to member ID cards. A QR code will also be added to member ID cards. When scanned, it will link to the member’s benefit summary document, providing them access to their plan’s deductible, their ER copay, their specialty copay, and more all at their fingertips. Upon renewal, Blue KC will be reissuing ID cards with a QR code for plans effective on or after January 1, 2022. Blue KC will be reissuing ID cards with this information included for plans effective on or after January 1, 2022. The mandate also requires member ID cards to include a telephone number and website address, which ours currently do.
- Surprise Billing: Blue KC members can feel confident that covered services they receive from non-participating providers at a participating facility will be covered as in-network (INN), and that they won’t face surprise Out-of-Network (OON) charges from providers. This includes scenarios where members receive a bill following healthcare services when they were unaware that they would face OON charges. For example, if a member visits a participating hospital for an emergency or scheduled surgery, but the anesthesiologist is a nonparticipating provider, the member is held harmless and cannot be balanced billed. The member will be billed based on INN benefits. Separately, all air ambulance services will be covered as INN as well.
- Cost Sharing Estimate and Price Comparison Tool: When the tool launches in Q1 2022, enrolled individuals will be able to receive price comparison guidance either by telephone or via our online cost tool on 500 items and/or services. Enrollees will also have access to the estimated cost-sharing they’ll be responsible to pay under their plan with respect to items or services furnished by participating providers within the geographic area of coverage.
- Provider Directory: Our enhanced directory will have the most up-to-date and accurate provider directory information available (including digital contact information such as e-mail addresses or website URLs when available). Changes to provider directory information will be reflected within 48 hours of being verified, so members can feel confident with the information Blue KC provides. They can also call Blue KC with a question related to a provider’s status. Lastly, Blue KC will also be sending the updated provider information to the Blue Cross Blue Shield Association (BCBSA) on a daily basis to ensure the national provider directory is also current.
For more information or if you have questions about Blue KC’s commitment to complying with the government mandates, please contact your Blue KC representative.