Reminder: Blue Cross’ concierge medicine policy

Health care providers must comply with affiliation agreements
As a reminder, Blue Cross Blue Shield of Michigan affiliation agreements require providers to:

Submit claims for covered services (i.e., services covered under a member’s benefit plan) directly to Blue Cross.
Accept our payment for covered services as payment in full.
Only charge the member the applicable copay or deductible (or both) for the covered service.
Not discriminate against members based on payment level, benefit or reimbursement policies.

We would like to remind heath care providers who want to use a concierge medicine model in their practices that they must ensure that its requirements are permitted by their affiliation agreements with Blue Cross Blue Shield of Michigan.

In a concierge, or retainer, practice, patients pay membership fees to a health care provider or third-party vendor for enhanced services or amenities. As a benefit of paying this fee, members typically receive:

Easy appointment access
Extended office visits
Enhanced email and telephone communication with doctors
Care coordination (including referrals) between the concierge practice and specialists
Wellness programs and plans, genetic and nutritional counseling, and risk appraisals

Providers may charge a concierge fee if:

Patients aren’t required to pay the concierge fee to become or continue to be a patient in the practice.
Patients aren’t required to pay the concierge fee to obtain access to the provider. Patients are only permitted access to ancillary providers (such as physician assistants or nurse practitioners) if they don’t pay the concierge fee.
The services or products being offered as part of the concierge fee aren’t considered covered services under our affiliation agreements, but instead aren’t covered under a member’s benefit plan. Because benefit structures vary significantly among our members, providers are expected to understand each member’s benefit structure to ensure that covered services aren’t included in the concierge fee.
Patients who don’t pay the concierge fee continue to receive the same level of access and services as they previously received.
Providers continue to meet Blue Cross and Blue Care Network performance standards regarding access and service.
The concierge level of service is clearly over and above usual practice in Michigan. Complaints from members who experience a decline in service level may result in Blue Cross concluding that the practice is noncompliant with the nondiscrimination clause of our affiliation agreements.

If you have any questions about the concierge medicine policy or need clarification, contact your provider consultant.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.