Friday, June 4, 2021

BCBS waiving cost-share during pandemic, but this is actually a disservice to people with Masshealth as a secondary

From BCBS website

Out-of-pocket COVID-19 costs are waived Telehealth costs for all covered services are waived All members can talk to a licensed doctor or provider from the comfort and safety of home, limiting the potential exposure to, and spread of, the virus. For the duration of the Massachusetts Public health emergency, we’ve waived member cost share* (copayments, co-insurance and deductibles) for all covered medically necessary medical and mental health services, provided via phone or video (telehealth) with in-network providers.  Call your provider to request remote visits by phone or video, and your claims will be processed to reflect these waived costs.* Members with our telehealth benefit are encouraged to use our Well Connection platform.  For Medicare HMO Blue and Medicare PPO Blue members: For Medicare HMO Blue and Medicare PPO Blue members: Until further notice, telehealth cost share will be waived for primary care visits, urgently needed visits, health risk assessments and outpatient mental health visits. In addition, cost share will be waived for telehealth visits by a specialist if the visit is related to COVID-19.  *Benefits may vary by plan

I spoke to someone in customer service, and what this means is that they are not charging any copays or 80/20 split for any telehealth services through July 1.

For people who have Masshealth as a secondary insurance, which is most children of low/moderate income, and many people with disabilities, what usually happens is that for services performed by providers who take both BCBS and Masshealth, the copay is billed to Masshealth. The BCBS deductible is then met through payments that come from Masshealth rather than the family. A sizable number of folks in my circle who have minor children with extensive needs purchase a child-only PPO plan from BCBS, which will reimburse at 80% pretty much any service for which the provider provides a proper bill regardless of whether they participate in insurance plans. I also know adults who purchase an individual BCBS plan in addition to their Masshealth plan. Child-only PPO plans are around $400 per month and adult individual plans are around $700. This allows people to get speech therapy, neuropsych evals, trauma treatment, occupational therapy, etc. from providers who do not directly bill insurance. 

What most of us do is schedule hospital-based visits (and especially the expensive ones...) like neurology and genetics as early as we can during the year. We don't pay anything out of pocket for the visits because Masshealth covers the out-of-pocket charges and the deductible gets largely met by these in-network visits. We then start getting reimbursed at 80% for private therapy services for the rest of the year. 

This year, BCBS is doing us a "favor" by not charging any co-pays or cost sharing. But what this means is that nothing is getting charged to Masshealth thus not going toward the deductible. So it's helping the families who make enough to not have a connector plan and who don't have disabilities and extensive costs, but is actually making it so the rest of us have an extra $5000 or so in out-of-pocket health costs this year. I asked and there is no way to opt out of this "favor." This is yet another example of why these decisions need to be made with people around the table who are low income, people with disabilities, etc. 

Of course, this was less annoying before Masshealth premium assistance stopped allowing members to use premium assistance for privately purchased plans a few years ago. I still don't understand the logic behind that; Masshealth was able to get out of paying most of a member's costs for only $300 a month or whatever it was that they reimbursed us for having the private plan. They now only offer this for people who have access to employer-sponsored plans (which are rarely PPO plans). 

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