IMPORTANT UPDATE FOR BLUE CROSS BLUE SHIELD of NC MEMBERS If you are a Blue Cross Blue Shield (BCBS) of NC member, there are changes to your plan beginning November 1, 2024 which may affect the services you are able to receive in our office. This will not affect State Health Plan or “out of state” BCBS plans.
Currently: Your chiropractic care can be automatically billed, without any need for approval or permission from BCBS. Essentially, if you have the covered benefit, you get the service(s), we bill them and get paid.
What’s changing? Effective November 1, 2024 the only service we can bill without issue will be your chiropractic adjustment(s). We will not be able to provide wobble, traction, or any other therapies provided at the chiropractic table (other than the adjustment) without obtaining a ‘pre-certification’ first.
What’s a pre-certification? Pre-certification requires that providers contact BCBS to ‘ask permission to use your benefits’. BCBS then decides whether or not they will ‘approve’ or ‘deny’ the services for which you have coverage BEFORE you are able to receive the service(s).
What this means for you?
- possible delay in care while we wait for pre-approval (can take 72 hours+ to receive a yes or a no from BCBS, the representatives are not entirely clear on this process yet)
- possible denials of requested services which you are used to receiving, and those which your insurance has historically covered.
- increased out of pocket expenses for you should BCBS decide you are not ‘pre-certified’ to receive covered items under your benefit. They will use the language “not medically necessary”.
What are we doing? We are pro-actively changing our workflow to accommodate this change, however, we have seen other insurance companies implement such policies, and ultimately what we see is limited approvals and/or denials of requested services. We hope this will not be the case here. We will do everything we can to get services covered (approved/pre-certified). What can you do? Insurance companies answer to their customers (that’s you all, not us). We encourage you to call the member number on the back of your insurance card and voice your concerns.
Have questions? Call or text the office and we’ll help 919.585.4885