Insurance Matters

Let's be clear about government mandates

February 2022

Because Blue KC is committed to putting patients first, we give you the critical information you need to make more informed healthcare decisions.  

We’re committed to complying with current government mandates and the requirements outlined under the Consolidated Appropriations Act (CAA) and Transparency in Coverage Rule (TCR) that go into effect in this year.  

What does this mean? As a member, you’ll be protected from surprise insurance bills, have access to up-to-date information about Blue KC’s in-network providers, and can compare costs when searching for a provider or healthcare services. Additionally, certain high-risk members will be able to receive continuing care at in-network rates for 90 days following a change in their provider’s network status. 

Here’s a closer look at how we’re giving members greater access to their health information, so they don’t face unexpected costs.  

We believe transparency is healthy. Don’t you?   

Member ID Card Changes 

As part of the requirements of the CAA, Blue KC member ID cards issued in 2022 have been updated to make cost-sharing information more transparent. Blue KC has added in-network major medical deductibles and applicable medical out-of-pocket maximums to your ID card. ID cards also feature a QR code which, when scanned, will link to a benefit summary document, providing you access to your plan’s deductible, ER copay, specialty copay, and more. Blue KC will reissue ID cards printed with these additional components upon renewal for plans effective on or after January 1, 2022. 

Would you like a digital version of your member ID Card that you can view, print, or email? It’s always available on the MyBlueKC mobile app or on  

Cost Sharing Estimate and Price Comparison Tool 

Thanks to this new tool, you can receive price comparison guidance either by telephone or via our online cost tool, on approximately 500 items and/or services. You also have access to the estimated cost share you will be responsible to pay under your plan with respect to items or services furnished by participating providers within the geographic area of coverage. 

Provider Directory Accuracy 

To protect you from out-of-network charges resulting from inaccurate provider directory information, we’ve enhanced our online directory to ensure the most up-to-date and accurate information is available. This includes digital contact information such as provider website URLs or email addresses. What’s more, changes to local and national provider directory information will now be reflected within 48 hours of being verified, so you can feel confident with the information Blue KC provides. You can also call Blue KC with a question related to a provider’s status.  

Surprise Billing  

We’ve put protections in place to ensure that you won’t face surprise Out-of-Network (OON) charges and balance bills when you unexpectedly receive services from non-participating providers within a participating facility. These protections are triggered when a claim is submitted for OON emergency or air ambulance services, or for certain scheduled services (for example, if you visited a participating hospital and surgeon for a scheduled surgery, but the anesthesiologist is a non-participating provider).

If your claim qualifies for these protections, it will be covered at your In-Network (INN) benefit, there will be a disclaimer printed on your Explanation of Benefits (EOB), and the provider will be made aware the claim should be identified as Surprise Billing unless you consented to OON charges prior to the service.

Please note that if certain criteria are met, OON providers may obtain your consent to balance bill for non-emergent services or post-stabilization services related to an emergency. You are not required to provide this consent, and you have the right to choose an INN provider.

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