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willdwyer / bcbsmaissuestracker

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Cascading issue - wording cut off in HMO Blue NE Ded $$ Plans #337

Open willdwyer opened 8 years ago

willdwyer commented 8 years ago

Hello,

This defect was reported by one of our BEs, and is encountered by the following steps:

  1. Generate a custom out of any of the below standard plans: 800236 800237 800238 800239 800240 800241 800242 800243 800244 800245 800246 800247
  2. Go to Common Medical Event, Imaging
  3. Input following language for L&E: 'Deductible applies first; copayment applies per category of test / day; pre-authorization required for certain services'
  4. Ensure 'Cascade All' is selected
  5. Save/Validate

Note, that the wording changes to 'Deductible applies first; pre-authorization required for certain services'.

Also note that this only seems to be evident in the Large Group 100+ HMO Blue NE $$ Deductible plans, but please fix globally.

sayotte7701 commented 8 years ago

Hi Will,

We have a rule configured which is as follows (pulled from the requirements for Imaging)

When “No charge” selected in In-network, remove occurrence verbiage from Limitations & Exclusions.

My guess is that "No Charge" is the value for these generated custom plans for the In-Network value. Could this be the case? Thank you

willdwyer commented 8 years ago

Thanks, Steve. I researched this in the product rules that are in HighRoads, and you are correct. When 'no charge' is selected in-network, then occurrence verbiage should be removed from L&E.

This may be a loop hole in the product rules, as this was discovered in an HCCS plan whose In-Network Lowest Cost Share value was "No charge", but has a copayment amount in In-Network Highest Cost Share value.

I will leave this assigned to me for now, under monitoring status. We may need to provide more clarity/detail on this rule. I will provide more information shortly.

This product rule may have to be changed, however, as this was encountered for an HCCS plan that had No charge in the In-Network Lowest Cost Share value, but a $$ amount in the In-Network Highest Cost Share value.