Blue Links for Employers

New Change to HMO and Blue Choice (POS) Plans That Could Reduce Your Costs

To help lower costs for employers and members, Blue Cross and Blue Shield may negotiate lower, out-of-network claims costs for covered services performed by out-of-network Massachusetts providers. This change takes effect in 2019 and applies to all employers with commercial HMO and POS plans.

Negotiations between us, or a contractor working on behalf of Blue Cross and Blue Shield, 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 may decrease employer payments and member out-of-pocket costs. For self-funded plans, the administrative services account agreement provides that when the related claims services described above result in a claim savings to the Account, Blue Cross and Blue Shield will charge the Account an amount equal to 30% of the claim savings. Savings are calculated as the difference between the original allowed charge and the newly negotiated reimbursement amount.

At this time, fee negotiation for HMO and POS plans will only apply to non-participating providers in Massachusetts. In the future, this practice may expand to include out-of-state non-participating providers. Blue Cross and Blue Shield will update our website to reflect changes in this practice as they occur.

If you have any questions about this change, please contact your account executive.

Blue Cross Blue Shield of Massachusetts

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.
® Registered Marks of the Blue Cross and Blue Shield Association.
© Blue Cross and Blue Shield of Massachusetts, Inc.
101 Huntington Avenue, Suite 1300, Boston, MA 02199-7611 | 1-800-262-BLUE (2583)