In the event that BCBSTX determines in advance that a proposed service is not a covered service, a Physician or other Professional Provider may inform the Member/Subscriber in writing in advance of the service rendered.  The Member/Subscriber must acknowledge this disclosure in writing and agree to accept the stated service as a non-covered service billable directly to the Member/Subscriber.

To clarify what the above means - if you contact BCBSTX and find out that a proposed service is not a covered service - you have the responsibility to pass this along to your patient (our Member/Subscriber).  This disclosure protects both you and the Member/Subscriber.  If the Member/Subscriber decides for the proposed non-covered service to be rendered then the Member/Subscriber is responsible for payment to you of the non-covered service.

Please note that services denied by BCBSTX due to bundling or other claim edits may not be billed to Member/Subscriber even if the Member/Subscriber has agreed in writing to be responsible for such services.  Such services are Covered Services but are not payable services according to BCBSTX claim edits.

revised 03/2010