Transparency in Coverage
These files are not designed for use by members. Members are encouraged to use the care cost estimator tool available on the Independence Blue Cross member website or mobile app. It is code to be used by researchers, government entities, and data aggregators to develop comparative data across health insurance issuers. These files are not a guarantee of coverage, nor a guarantee of the reimbursement rate that will be applied for any procedure. The claims reimbursement process is subject to a variety of factors that are not addressed in these files, including eligibility, medical necessity determinations, utilization management requirements, exclusions and other plan terms. These files also do not offer any information on a member's out-of-pocket charges.
These files must be opened using a specialized .JSON file reader. If a .JSON file is opened using a standard business application (such as Microsoft Word).