Capital BlueCross: Benefit Change to Clinic Fees

Capital BlueCross wants to help their members make informed decisions about their care by having open conversations with their physicians about transparency in billing practices.

As permitted, some hospital-based outpatient clinics bill Capital BlueCross two charges: one for the use of the clinic, and another professional service charge for physician visits. Capital BlueCross processes the clinic fee as an outpatient facility charge, which means the member may have a cost share on this part of the claim.

Effective immediately, groups will no longer be given an exemption that waives these charges. Existing groups that have an exemption will be given the option to continue to opt-out on their non-HSA plans only.


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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.