Hold Harmless and Balance Billing

Policy Number: GP-X-006

Last Updated: Jan. 1, 2022 

In-network providers are not permitted to “balance bill” a Blue Cross and Blue Shield of Nebraska (BCBSNE) member for amounts more than the BCBSNE allowance for covered services. Providers are also responsible for the cost of billing claims and any collection service activities they may require.  

Providers and their associated billing services and/or collection agencies that improperly balance bill BCBSNE members will be in violation of the provider contract. Once notified, the provider must promptly take necessary steps to halt any such activity. If balance billing is not stopped, the provider may be terminated from participating in any BCBSNE networks.  

A provider may bill the covered person for services, procedures, drugs, supplies and medical equipment when BCBSNE has applied amounts to deductible, coinsurance or copay, and where services are denied as not covered by the member’s benefit plan. For a provider to be allowed to bill the member for services that are denied as not scientifically validated, investigative or not medically necessary, two conditions must be met: 

  1. The provider must have advised the member in writing that the member is likely to be financially liable for the services provided. Documentation must show the provider informed the member of the total out-of-pocket costs for which the member could be liable. 
  2. The Advanced Beneficiary Notice (ABN) or waiver documentation must have been presented to and signed by the member prior to the service being rendered. 

If written agreement cannot be obtained from a member, verbal notification may be given by the provider, but it must be documented in the patient’s medical records at the time the notification is given.* For all other balances, the provider agrees not to bill or collect any amount from the member.  

*NOTE: For members covered under a Federal Employee Program (FEP) plan, the ABN or waiver must be presented and signed by the member. Medical records will not be accepted as proof of ABN.