Get the Most Out of Your Zero Dollar Office Visits

Helping our members and their families live better, healthier lives is our top priority here at Blue Cross Vermont. One of the ways we do that is by offering zero-dollar office visits in many of our qualified health plans (QHPs), purchased either through Vermont Health Connect or directly from us.

What’s a zero-dollar office visit? It’s when there’s no cost-sharing for an office visit with an in-network primary care, mental health, or substance use disorder treatment provider. There’s no copayments or coinsurance for the office visit, and the plan’s deductible doesn’t apply, either. 

Zero-dollar office visits enable our members to see some providers without any financial barriers. We’ve included them in most of our QHPs to encourage members to get treatment early on, rather than delaying care. This approach is better for everyone. By addressing health problems in their early stages, our members remain healthier and stay more active. The overall cost of care is lower, too.

In this article, we take a closer look at zero-dollar office visits and provide some tips for how you can get the most out of them.

Plans With Zero-Dollar Visits

In our 2024 QHP individual and family plans comparison chart, there is a column for the cost of primary care, mental health, or substance use disorder treatment provider visits. In it, you’ll see that our Vermont Preferred plans have combined 4-8-12 zero-dollar office visits. That means members enrolled in the Vermont Preferred Gold, Silver, or Bronze QHPs can see their primary care, mental health, or substance use treatment providers without cost-sharing for office visits, as follows:

• Individual plan, up to four visits
• Two-person plan, up to eight visits
• Family plan, up to 12 visits

Preventive services, such as prostate screenings and mammograms, are not covered under zero-dollar office visits, as we already provide benefits for them without cost-sharing.

In two-person and family plans, the zero-dollar office visits can be shared between people covered by the plan. For example, if a family member uses two of their plan’s 12 zero-dollar office visits during a year, the remaining 10 zero-dollar office visits are available for other family members to use during the same year. When all the plan’s zero-dollar office visits are used up, then deductibles and other cost-sharing will apply to subsequent visits.

Members who’ve been diagnosed with heart disease or diabetes have additional zero-dollar office visits, under our Vermont Preferred plans. Each member can see a specialist up to four times without any cost, including a:

• Cardiologist
• Endocrinologist
• Nephrologist
• Ophthalmologist
• Podiatrist (some exclusions apply)

For specialists, the zero-dollar visit does not include any related laboratory, diagnostic, or treatment services received during the office visit. Cost-sharing and deductibles apply after the four zero-dollar office visits are used up.

Several of our Standard QHPs (Platinum, Gold, Silver, and Bronze Integrated) include three zero-dollar office visits per member for primary care, mental health, or substance use disorder treatment provider visits. Our Catastrophic plan also includes zero-dollar office visits (three for an individual plan, six for a two-person plan, and nine for a family plan).

Preparing for a Visit

Before you head off to your zero-dollar office visit, here’s how you can prepare to make the visit more productive.

• Decide what to discuss. Think about what you want to talk to the provider about and write it down. If there’s more than one topic, make a list and rank them by importance. Write down all the questions you want to ask, as well.
• Gather your history. If you haven’t seen the provider before, bring your medical history, names of other doctors you’ve seen, and a list of the prescription and over-the-counter medications you’re taking. A copy of your family medical history would also be helpful. If you’ve seen the provider previously, bring a list of the things that have changed since your last visit.
• List your symptoms. The provider will probably want to know about the symptoms you’re experiencing. Make a list of them ahead of time so that you’ll be prepared and won’t leave any out. You can also keep a symptom diary in the days or weeks before the visit, which includes when each symptom started, how frequently it occurs, and how long it lasts. Be sure to bring the diary with you to the appointment.
• Take your tracker logs. If you track your health data, such as blood pressure or heart rate, bring any logs you have.   

Once you are in the provider’s office, here are some things to do:

• Take notes. It’s helpful to write down what the doctor or provider says so that you can refer to it later. Some people prefer to bring another person with them to be a second set of ears.
• Don’t rush. It’s important to take your time and get your questions answered.
• Speak up. If you don’t understand something, speak up and let the provider know what’s unclear.
• Get educational materials. Ask the provider for printed materials about your condition to review at home. Likewise, be sure to leave with written instructions about what the provider wants you to do.

Schedule Your Appointment

We hope you’ll take advantage of any zero-dollar office visits that are included in your health plan to address your health concerns.

Please remember that a health care provider may be booked up for several weeks, or even a few months, so it’s best to schedule your appointment as soon as possible. If you need to find a provider, please use our online Find a Doctor tool.

If you are not sure whether your health plan includes zero-dollar office visits, or if you have a question, please give our customer service team a call at the number on the back of your member ID card.