Tag: blue cross blue shield of massachusetts

Coordination of benefits. Which plan is primary?

October 15th, 2020 by
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Get your act together!

I received a couple of ominous looking letters from Boston Children’s hospital, letting me know that my claim has “been suspended” by my insurance carrier, Blue Cross Blue Shield of Massachusetts.

Unlike a couple months ago, when Blue Cross accidentally cancelled my family’s entire policy (oops!) while trying to remove an adult dependent at my request, this time it was due to a “coordination of benefits” issue.

Here’s the situation. Another dependent of mine is a college student in a different state. Our Blue Cross HMO doesn’t work out of state, so we buy an additional insurance plan from the college. (Also one more policy for varsity athletic participation, but that’s another story!)

When this dependent had services at Boston Children’s, we listed the Massachusetts plan as primary. But at least according to the BCBS MA rep I spoke with today, the out-of-state plan should be primary because my dependent is the subscriber, unlike on our family plan where they are listed as a dependent. So even though the out-of-state plan is likely to deny the Massachusetts claim as out-of-network, we need that denial first before submitting to BCBS MA. Make sense?

Oh, and to make things a little more complex, the rep said I need to ask the other plan if they follow the “standard coordination of benefits rules.” Apparently some student plans don’t.

What fun!


By healthcare business consultant David E. Williams, president of Health Business Group

How to get Noom for free

March 31st, 2020 by

Noom combines an app with human coaching to help people lose weight and keep it off. The company’s typical user loses 7.5% of body weight over the course of a four month program.  Customers are joining like crazy, and revenue quadrupled last year.

After hearing about Noom on NPR late last year I signed up, paying $44.99 per month. To put it in perspective, that’s almost twice what I pay for my gym. Plus, my health insurer, Blue Cross Blue Shield of Massachusetts actually reimburses me for three months of gym membership.

And that got me thinking, if Blue Cross pays for me to stay fit at the gym, maybe they would pay for my weight loss program as well. After all, trimmer people cost insurers less money. So I called Blue Cross and they told me they actually do cover weight loss plans, the same way they cover gym memberships.

Once I found out about the benefit, it was incredibly simple to get reimbursed. I typed in some basic information online, uploaded my Noom receipt –and today I received a check for the full amount of my Noom membership. No co-pays, no deductibles, no negotiated discount!

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Online form

It wasn’t easy to find, though, so I’m writing this post to give others a heads up. Here’s where I had to go on the Blue Cross site to find the benefit:

  • Login> My plans> Plan Details> Plan Benefits> Benefit Details> Routine Adult Physical Exams Covered By Your Plan
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Where’s Weight Loss?

Buried at the bottom of a run-on paragraph with no line breaks, I found the following run-on section with weird punctuation and a typo:

Weight Loss Benefit – you and your covered family members can be reimbursed for up to 3 months of participation fees paid to a weight loss program that is hospital-based; or one that is non-hospital-based program focused on eating and physical activity habits, and behavioral/lifestyle counseling with certified health professionals (in-person, by phone, or online). You can request this reimbursement once each calendar year; requests must be submitted by March 31 of the following year.

Bingo! (Although can someone explain why on earth this would be in the physical exams benefit?)

Noom isn’t specifically mentioned, but when I called Blue Cross they assured me the company was on the list. They also told me my call was being recorded in case I was denied and wanted to complain later! That was comforting.

Anyway, the moral of this story is to check with your health plan to see if they’ll pay for Noom. You might be pleasantly surprised. And who couldn’t use a little break during these tough financial times?

Gay rights states get a tax break

July 23rd, 2013 by

Gay marriage has been legal in Massachusetts for several years. Health plans have responded by treating gay couples the same as straight couples. But thanks to the federal Defense of Marriage Act (DOMA), benefits that employers paid for same-sex spouses were treated as taxable income. That created a serious disincentive for same-sex spouses to sign onto their partners’ plans.

But last month the Supreme Court struck down key parts of DOMA. And that means more same-sex couples are likely to take up employers on their offer of health insurance coverage. In response, health plans like Blue Cross Blue Shield of Massachusetts are offering special open enrollment periods to allow same-sex couples and their dependents to enroll in employer-sponsored plans.

The Supreme Court’s decision doesn’t legalize gay marriage in states where it’s banned, so as far as I know the uptick in enrollment that’s expected in Massachusetts won’t be matched everywhere.  Liberal social policies like gay marriage help Massachusetts flourish by drawing in and retaining well-educated, talented people. The Supreme Court’s decision gives Massachusetts and similar states an additional edge.