Blue Review
A newsletter for contracting institutional and professional providers

October 2019

Laboratory Benefit Level Change for Some Members

Currently, Blue Cross and Blue Shield of Illinois (BCBSIL) covers many non-preventive lab services without any member cost sharing when billed with a preventive diagnosis.  

Beginning Jan. 1, 2020, or upon a member’s renewal date, non-preventive labs will no longer be covered at the no member cost-share level for some of our PPO and HMO members but will instead be treated as a standard medical benefit regardless of diagnosis code. Any applicable cost sharing (copay, coinsurance and deductible) may apply, based on the member’s health plan.

What does this mean for you?

  • You may have to seek payment from both BCBSIL and the member.
  • You may want to alert members that they could have to pay any applicable cost share (copayment, coinsurance, deductible) for laboratory services. 

Please refer to the Preventive Services Clinical Payment and Coding Policy, which contains the list of lab procedures that are considered preventive and will process at the no cost share benefit level when billed with a preventive diagnosis.

As a reminder, it is important to check member eligibility and benefits through Availity® Provider Portal or your preferred vendor web portal prior to every scheduled appointment. Eligibility and benefit quotes include membership status, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. Checking eligibility and benefits also helps you confirm benefit preauthorization requirements. Also ask to see the member's ID card for current information and a photo ID to help guard against medical identity theft. When services may not be covered, members should be notified that they may be billed directly. Obtaining benefit preauthorization is not a substitute for checking member eligibility and benefits.

To confirm how a lab will process if it’s not identified on the Preventive Clinical Payment and Coding Policy, call the number on the member’s ID card and ask about the member’s non-ACA wellness benefit.