What Happens to My Coverage If I Don’t Pay My Bill on Time?

You pay in advance for your coverage.

You confirm your enrollment when you make your first payment. So it’s important that you pay your bill on time and in full. If you don’t, your plan could be canceled.

After making your first bill payment, you'll have a grace period on your Blue Cross Blue Shield of Michigan coverage if you don't pay your health care bill on time. You'll need to pay anything you owe by the time the grace period ends. If you don't, you could risk losing your coverage.

If your payment doesn’t go through or you don’t have enough money in your account to make the full payment, we’ll send you a letter to let you know. As soon as you know, call the customer service number on the back of your Blue Cross ID card. We’ll take your payment over the phone so you'll be able to use your coverage.

If you don’t pay your bill on time, you will enter a grace period. If we do not receive payment in full, you may have to pay for any health care services you received during your grace period. Unless your plan has been canceled, we’ll start your coverage back up as soon as we get your payment in full.

The grace period is 31 days if you aren't eligible for the advance premium tax credit or you bought your coverage directly from us. During that time your claims will be pended.

If you’re eligible for and receiving the advance premium tax credit, your claims will be processed differently than normal during a 90-day grace period.

• During the first month, we will pay your claims normally.
• During the second and third months, your claims will be pended. That means they’ll be held by us and will not be paid or denied. Any pharmacy claims will be rejected. You’ll need to pay out-of-pocket for them.
• After three consecutive months without payment in full, you’ll be responsible for any pended claims.

A retroactive denial may occur after a service is performed and your provider has billed us for this service. Retroactive denials can occur when:

• Claims are pended during the second and third month of a grace period and the member fails to pay their premium within the required timeline to continue coverage. The member will be held liable for the cost of services for claims rejected by the plan. 
• Prior authorization for a service is required but there has been no request for review (prior authorization) to determine medical necessity.
• Services have been provided and the benefit has been exhausted.

To prevent retroactive denials:

• Be sure your premiums are paid on time. 
• Ensure that your provider has submitted the necessary information in situations where a prior authorization is required. 
• Be sure to know your benefits and do not use them without being sure your services are a benefit.