We've made a change to the administrative services account agreement that provides us, or a contractor working on behalf of Blue Cross, with an expanded ability to negotiate lower, out-of-network claims costs for covered services. This change to the account agreement applies to self-funded employers covered by a commercial PPO plan upon account renewal in 2014. Negotiations with us, or a contractor working on behalf of Blue Cross, and out-of-network health care providers may take place after a claim is made. If negotiations are successful, the out-of-network provider will then be reimbursed the new, lower amount.
Reducing the claims costs for out-of-network claims decreases employer payments and member out-of-pocket costs. As described in the revised administrative services account agreement, you'll receive 75 percent of any savings generated through successful negotiations. Savings are calculated as the difference between the original allowed amount and the newly, negotiated allowed amount.
If you have any questions about this change, please contact your account executive.