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45 11/2005
Collecting Payment from Members
Under their membership agreements, BCBSGa/BCBSHP members and guest members
may be responsible for paying some portion of the bill for health care services
rendered by network facilities. Members may be responsible for any of the following:
emergency room copays, deductibles, coinsurance, and non-covered services.
• Emergency Room Copayment – a fixed payment made by member at the time a
service is rendered.
• Deductibles – a fixed dollar amount that members must pay out-of-pocket for
covered services before the Plan will pay benefits.
• Coinsurance – Coinsurance is usually a fixed percentage of the allowed charges for
covered services.
• Non-covered Services – a service not covered under the terms of the Membership
Agreement. BCBSGa/BCBSHP members are responsible for payment for services
that are not covered under their Membership Agreement.
If possible, BCBSGa/BCBSHP members should pay their emergency room copayments
at the time services are rendered. The member ID card will indicate if the member’s
coverage includes an emergency room copayment. BCBSGa/BCBSHP facilities should
bill members for deductibles, coinsurance amounts and non-covered services after
BCBSGa/BCBSHP has adjudicated a claim for services and determined true member
liabilities based on the member’s benefit agreement and the terms of the provider’s
agreement with BCBSGa/BCBSHP. Providers will receive a remittance advice reporting
Plan payment for services and amounts billable to the member. Members should not
be billed for charges associated with those services which do not appear as member
liability on the remittance advice. Providers should call the Dedicated Facility help line
or customer care department with any questions regarding Plan payment or member
liabilities.
Dedicated Facility help line (800) 284-2609
BlueCard Program help line (800) 628-3988
Customer care department (800)241-7475