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Privacy Regarding Member Self-Paid Services or Items

Please note that this information replaces the article that first appeared on this topic on August 9, 2013.

Blue Cross and Blue Shield of North Carolina (BCBSNC) is committed to protecting the privacy of our member’s medical and personal information.  Under recently updated HIPAA privacy regulations, a member may pay the total cost of a medical service or services and request that a provider keep information about that service or services confidential.  In these instances, providers are required to abide by the member’s request and not submit a claim to BCBSNC for the specific service(s) in question.

Under current regulations, providers may collect the cost of a service or supply provided to a member from that member, if the member requests nondisclosure of his or her protected health information to BCBSNC, and provided the member is personally paying for the costs out of pocket for such a service or supply.  The member should be advised, in advance of services being provided, the amount of their financial responsibility, if electing to request a claim to be withheld from submission to BCBSNC, and providers may collect from the member an amount up to their standard charge amount for that particular service or supply.

Additionally, providers are not permitted to (i) submit claims related to, or (ii) bill, charge, seek compensation, remuneration, reimbursement, or collection from BCBSNC for services or supplies provided to a member, if the member has requested that no claim be submitted to BCBSNC and the member is paying for the charge out of pocket.  

Please note that withholding claims and billing members for unfiled services and supplies is allowed only when requested by the member for the member’s own privacy and confidentiality.     

 If you have any questions, please contact the Provider Blue LineSM at 1.800.214.4844.