Blue Cross Blue Shield of Michigan Threatens Access to Care
Beginning July 1, 2025, Blue Cross Blue Shield of Michigan required clinicians to use CPT codes 98000–98015 for telehealth evaluation and management visits, instead of the familiar office codes 99202–99215. Claims submitted under the traditional codes are now getting rejected. BCBSM’s announcement
These are national CPT codes—not codes invented by BCBSM. The problem is BCBSM’s decision to reimburse our practice approximately 15% less for telehealth care.
A coding change does not justify a pay cut
BCBSM explains how providers must bill these visits, but its public materials do not meaningfully explain why the care should be worth less.
The American Medical Association describes the new codes as E/M services structured similarly to office E/M and selected according to medical decision-making or time. American Medical Association
A different billing label does not make a clinician’s judgment, responsibility, or liability 15% cheaper. If BCBSM has evidence supporting this reduction, it should publish it.
Where the money actually goes
The 15% cut comes on top of the enormous cost of dealing with insurance companies in the first place.
Our practice must allocate approximately 6.5% of all insurance payments to billing work—including submitting claims, correcting errors, fighting denials, following up on unpaid claims, and getting paid for services we have already provided.
We must then reserve another 5% to 10% of the remaining revenue in case an insurer later audits a claim and attempts to recoup money it previously paid. That money may still belong to the practice, but it cannot safely be used to meet current expenses.
Consider a telehealth service that would otherwise be reimbursed at $100:
BCBSM’s 15% reduction leaves $85.
Billing and insurance-administration costs reduce that to approximately $79.48.
Maintaining a 5% to 10% recoupment reserve leaves only about $71.53 to $75.50 available for current expenses.
That remaining amount must cover administrative staff, rent, malpractice insurance, technology, the electronic health record, licensure, regulatory compliance, and every other expense required to keep the practice operating.
Only after those bills are paid can the clinician be paid. That income must also support student-loan payments and advanced clinical training—the education that allows us to provide better care to patients.
This is not a story about a practice refusing to control its expenses. It is a story about how much is consumed by the machinery required to obtain and protect payment from insurers.
Telehealth does not eliminate overhead
Our practice treats patients with complex and sometimes high-acuity psychiatric conditions. We maintain a physical office so we can provide injections, obtain laboratory testing, meet with patients in person, and respond appropriately when someone is in crisis.
Telehealth does not eliminate our rent, staff, malpractice coverage, billing expenses, or clinical infrastructure. It adds secure technology and administrative requirements while the physical office remains necessary.
Meanwhile, consumer prices in the Detroit metropolitan area were 4% higher in June 2026 than one year earlier. U.S. Bureau of Labor Statistics
BCBSM is paying less even though the cost of safely caring for patients has not decreased.
Why we continue accepting insurance
We accept insurance because we know psychiatric care would be inaccessible to many members of our community if they had to pay entirely out of pocket.
But we are approaching a point where long-term in-network participation may no longer be financially sustainable. Leaving the network could expose patients to higher bills and disrupt established treatment relationships. Remaining in a system that continually reduces payment while increasing administrative costs could threaten the survival of the practice itself.
Neither outcome is good for patients. A financially unstable practice cannot continue serving anyone.
We are caught between a rock and a hard place: remain in network under increasingly unsustainable conditions, or leave the network and make care more expensive for the people we are trying to help.
Patients deserve answers—and political accountability
Michigan law requires insurers to cover qualifying telehealth services when the corresponding in-person service is covered, but it does not clearly require equal reimbursement. Michigan Compiled Laws § 500.3476
BCBSM should publicly explain what evidence supports its 15% reduction, how it accounted for the fixed costs of hybrid practices, and whether it studied the policy’s effect on network access.
Elected officials should be asking those questions. Campaign contributions are not proof that anyone has been bribed or “paid off.” But insurer PAC money can create access and an appearance of influence—especially when lawmakers fail to address policies benefiting the contributing industry.
Current public records show:
State Representative Morgan Foreman’s campaign reported $250 from the BCBSM PAC during the 2026 cycle. Campaign record
State Senator Jeff Irwin’s campaign reported $3,000 from the BCBSM PAC during the 2022 cycle and another $1,500 during the 2024 cycle. 2022 record | 2024 record
U.S. Representative Debbie Dingell’s campaign received at least $51,500 from the BCBSM PAC in the federal records we reviewed from 2014 through June 2025. Contribution history
These records do not establish wrongdoing. They do give constituents every right to ask whether their representatives will stand up to BCBSM and protect access to care.
Telehealth is real medical care delivered by licensed professionals carrying real clinical responsibility. Practices cannot absorb lower reimbursement, rising expenses, denial costs, and unpredictable recoupments forever.
Something has to give—and it should not be patients’ access to care.
