You may have heard from a local provider about a change in how we pay doctors when multiple services are provided in a single visit. We want to provide additional context about the policy, why it exists and what it means for your employees.
The provider, Empire Dermatology, has contacted employers and members about this policy.
Our responsibility to you
As you know, rising healthcare costs affect the premiums employers pay and the out-of-pocket costs employees face. We have a responsibility to manage those costs carefully by paying appropriately for care, while continuing to support access to high-quality treatment.
What has changed
Our new policy applies when an office visit and a minor procedure are performed during the same appointment.
When multiple services are provided during the same visit, some resources are shared such as patient intake, use of the exam room, and medical record review.
In those cases, reimbursement is adjusted to account for those shared costs to avoid paying twice for the same underlying resources, thus reducing waste. We believe that when care can be safely and appropriately delivered in a single visit, it should be.
The policy does not change members' benefits, coverage or access to medically necessary care. Providers like Empire Dermatology will continue to be paid for their time, medical judgment and the care they provide when multiple services are provided on a single visit.
Other health plans have also made this change, and the Centers for Medicare & Medicaid Services (CMS) has recently proposed this payment policy in the 2027 Medicare Program.
Why we made this change
The policy is intended to reduce waste, promote accurate reimbursement for medically necessary services, improve efficiency, and protect members’ premium dollars.
Applying payment policies consistently helps ensure healthcare dollars are spent appropriately and supports our broader efforts to improve affordability.
Support for members
In response to this policy, the provider has said they may ask patients to make additional visits that may not be medically necessary. We believe that would be an abuse of the system. Unnecessary return visits burden members with additional office visits, out-of-pocket expenses, and delay of medical care. Providers like Empire Dermatology should not place its financial objectives above medical necessity and then attribute the resulting inconvenience, delay, and expense to Excellus BlueCross BlueShield.
We continue to encourage care that is clinically appropriate, convenient for patients and delivered as efficiently as possible.
If a member has questions about their experience at their provider’s office, they can reach Customer Care at the number on the back of their member ID card.
We will continue to review provider feedback, monitor member experience and evaluate the policy's impact as it is implemented.
For the latest news and updates, visit: News & Updates | Employers | Excellus BlueCross BlueShield
