| If your practice is in North Carolina I am sure you are aware of the changes in benefits that BCBS NC has implemented beginning the first of the year. For those of you who sometimes see a Blues patient from North Carolina, you should also be aware of these changes.
As of December 30th of this year, almost all members of BCBS NC will be limited to one vein treatment per leg per lifetime. Sclerotherapy is limited to three sessions per lifetime. In discussing these changes with the Medical Director at Blues of NC, he made it very clear that this is NOT a medical or clinical decision. This change was promulgated at the Benefit Plan design level. The one positive note is that BCBS NC will not be retro-reviewing to see if the patient had treatment in the past year or two already.
One way to think of this change is to consider chiropractic coverage. Some plans have chiropractic coverage by design and some plans do not. Appealing to the Medical Director to somehow obtain chiropractic coverage would be futile. Unfortunately, this is the scenario we are facing with the new restriction regarding venous treatment.
Our recommendations:
1. Send complaint letters to the President and CEO of BCBS NC, Mr. J Bradley Wilson.
3. After meeting conservative therapy and clinical guidelines, you may still treat the patient within the limitations outlined.
4. Any other services the patient may need will have to be cash pay. An example might be treating the GSV on the right leg then treating the GSV on the left leg on a different day. Those should be covered. Finally, at a cash price treat both SSV’s the same day. Be sure to work out a cash pay price and payment processes with the patient before rendering treatment.
These changes apply to virtually all patients with BCBS NC insurance. Federal Blues is not impacted by this benefit plan change. |
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