You Have Protection Against Surprise Medical Bills

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A new law brings greater transparency and protection to your health care. We're breaking the law down so you know your rights and can take full advantage of these additional protections.

As Vermont’s only local, non-profit health plan, we shield our members from major health care costs. A new federal law known as the No Surprises Act is helping us expand protections for you. We want to make sure you are aware of these additional protections so you can take full advantage of them.

Billing Ban
When an out-of-network provider bills members for the difference between their initial charges and what Blue Cross pays, this “balance bill” can result in some costly surprises. We’ll now be able to protect members from such bills when they receive care:

  • In an emergency
  • At in-network facilities, with out-of-network providers

In these situations, Blue Cross has 30 days to deny or pay claims from out-of-network providers. If a provider doesn’t like a payment decision, Blue Cross will negotiate with the provider for up to 30 days. If a settlement isn’t reached, then an independent dispute resolution process determines final payment. Members are not involved in this process at all.

The good news for you is that whatever the outcome, you’ll pay no more than your usual in-network cost sharing amounts, including deductibles, co-insurance, and co-pays.

One important thing to be aware of: There are limited situations where providers can ask patients to waive their rights to protections. So be sure to read any waiver requests carefully.

New Info on ID Cards
We’re adding information to your member ID card to help you better understand your cost sharing amounts. On the card you’ll see:

  • In-network and out-of-network deductibles
  • In-network and out-of-network out-of-pocket maximum

Some members have already received an updated card, others will get one soon. If you need help understanding your costs, please contact our Customer Service team at the number on the back of your ID card.

Price Comparison Tool
To help consumers estimate and compare health care costs, health plans must now maintain a price comparison tool. We think this is a great feature and offered it to our members even before the legislation came along. You can access our price comparison tool through the Member Resource Center (MRC). If you don’t already have a MRC account, you can create one here or contact our Customer Service team at the number on the back of your ID card.

Updated Provider Directories
To make it easier for you find an in-network provider, we maintain a provider directory. Information is updated at least every 90 days. If provider information is incorrect, you’ll only be responsible for in-network cost sharing. We work with providers to ensure the accuracy of their information and frequently update the directory. If you do find an error, please contact our Customer Service team at the number on the back of your ID card.

Greater Transparency Coming
Health plans and providers will soon be more transparent about how much medical services cost and what you’re expected to pay. The goal is to help you better understand the cost of care up front.

Providers and facilities will be required to give you an estimated cost for services after you make an appointment. Providers must also send that estimate to Blue Cross, and we’ll let you know:

  • Our cost estimate (including your share)
  • Status of your deductible and out-of-pocket maximum
  • Whether the provider is in-network
  • Whether the service requires prior approval
  • Your current accumulated cost sharing amounts

The transparency rules are not final yet. Once they’re complete, we’ll be moving as quickly as possible to give you more insight into costs to help you with making health care decisions.