What are the covered charges that are held toward my deductible?

    Covered charges subject to the deductible are those that are payable at 90% of the reasonable amount.  You can find examples of these charges in your Plan Coverage Booklet under the Health Care Benefits section.  Some of these are included on the pages under outpatient hospital benefits, skilled nursing facility benefits, therapy benefits, miscellaneous and other benefits.

Do other types of expenses count toward the deductible?

    No.   The deductible does not apply to inpatient hospital charges, surgery charges, human organ transplant benefits, lab and x-ray charges, hospice care benefits, cancer screening benefits, chemotherapy and radiation therapy, or home health care benefits.

What if I don't have enough expenses to satisfy the deductible by the end of the year?

    If any part of the calendar-year deductible is satisfied by charges incurred during the months of October, November and December, these charges will be carried over to the following calendar year.

What are the advantages of seeing an "in-network Participating Provider?"

    Seeing an "in-network participating provider" has distinct advantages over visiting a non-participating provider. Participating providers agree to accept a pre-established BCBSM approved amount as payment in full for service. Your out-of-pocket cost is limited to the co-pay (if any) specified in your MESSA health plan (some plans also carry an annual deductible amount).

"Non-Participating Providers" on the other hand set their own fee. You are responsible for the difference between the BCBSM approved amount and the non-participating provider’s total fee. Some non-participating providers will still bill BCBSM/MESSA for the approved amount, while others require payment-in-full from you. You are then responsible for submitting receipts to MESSA for reimbursement of the approved amount.  If you are enrolled in the Choices II PPO plan and you use out-of-network Non-Participating Providers, you will be responsible to pay a $250 per individual/$500 for family deductible per calendar year before MESSA will pay for services.  See your Choices II Plan Coverage Booklet for more details. 

How are my health care bills paid and how do I know what is applied toward the satisfaction of my required deductible?

    When seeing a "Participating Provider," simply present your MESSA/Blue Cross Blue Shield of Michigan ID card and your provider will submit the claim for you.  If you owe any balances, either for your deductible, co-payment or services not covered, the doctor may bill you later.  You will receive a confirming worksheet - Explanation of Benefits (EOB) from MESSA showing the charges held toward your deductible and any payment to your provider.

   

When seeing a "Non-Participating Provider," submit your claims to MESSA as you incur them.  MESSA will send you a worksheet showing the amount held toward your deductible.  Once your charges satisfy the deductible, you will be reimbursed for 90% of the balance of covered charges over the deductible amount.

For complete details about your coverage, please refer to your Plan Coverage Booklet or call MESSA Membership at 800.292.4910.