Government Mandates are designed to remove health system barriers so that patients have greater access to their health information and don’t face unexpected costs.
In the last issue of The Brief, we provided an overview of key requirements under the Consolidated Appropriations Act (CAA) and Transparency in Coverage Rule (TCR). In this issue, we’ve provided more context regarding the three key member benefits in support of CAA.
Member ID Card Changes
As part of the requirements of the CAA, Blue KC member ID cards issued for 2022 will be updated to make cost-sharing information more transparent.
Blue KC will be adding members’ in-network major medical deductibles and applicable medical out-of-pocket maximums to their ID cards. ID cards will also feature a QR code which, when scanned, will link to their benefit summary document, providing them access to their plan’s deductible, ER copay, specialty copay, and more. Blue KC will be reissuing ID cards printed with these additional components upon renewal for plans effective on or after January 1, 2022.
Encourage your employees to get a digital version of their member ID card they can view, print or email.
Provider Directory Accuracy
To protect members from out-of-network charges resulting from inaccurate provider directory information, we are enhancing our online directory to ensure the most up-to-date and accurate information is available (including digital contact information such as the providers website URLs or in some cases email address). Changes to local and national provider directory information will now be reflected within 48 hours of being verified, so members can feel confident with the information Blue KC provides. Members can also call Blue KC with a question related to a provider’s status.
Surprise Billing
Blue KC members can feel confident they will be protected from surprise medical bills and balance billing covered services that were unexpectedly received from a non-participating provider performing services within a participating facility. Beginning in 2022, at the start of a new health plan or upon renewal of an existing plan, surprise billing protections will be effective. Under these protections, qualifying claims will be covered at the member’s in-network benefit, and the member won’t face a surprise balance bill from the non-participating provider.
These protections apply to certain scenarios in which members were unaware they would be responsible for out-of-network cost sharing or balance bills from non-participating providers. For example, if a member visits a participating hospital for an emergency or scheduled surgery, but the anesthesiologist does not participate in the member’s network. Additionally, all air ambulance services will be covered at in-network benefits. If certain criteria are met, non-participating providers may obtain consent from the member to balance bill them for non-emergent services or post-stabilization services related to an emergency.