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Privacy Regarding Member Self-Paid Services or Items

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.

Unless otherwise permitted by law or regulation, the amount charged to the member for a service or supply may not exceed the BCBSNC allowed 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 call the Provider Blue LineSM at 1.800.214.4844.