As previously communicated in Partners in Health Update, IBC announced there is
no member cost-sharing ($0) for certain preventive services provided to certain
members. These new cost-sharing rules are mandated by the Federal Health Care
Reform act known as the Patient Protection and Affordable Care Act of 2010. The
$0 copayment does not apply to
problem-focused services. Problems that can easily be assessed and dealt with
as part of the preventive services, such as blood pressure or cholesterol
management, do not meet the criteria for collection of a copayment. However, if
the member is experiencing a significant problem that requires a
problem-focused service that cannot be handled as part of the preventive
services, such as a breast mass, uncontrolled diabetes requiring adjustment of
medications, and follow-up at a shorter interval than would be normally
anticipated, it would allow for cost-sharing.
For questions regarding member
benefits, log on to NaviNet and select Eligibility
and Benefits Inquiry from the Plan Transactions menu. You can also use
the Provider Automated System by calling 1-800-ASK-BLUE.