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Thread: Blue Cross and Blue Shield insurance

  1. #1
    Optician Extraordinaire
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    Blue Cross and Blue Shield insurance

    Does anyone else find this insurance the worst to get authorizations for? Most of the others are so easy, but with BCBS it takes so much time.

  2. #2
    Master OptiBoarder Joann Raytar's Avatar
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    You can turn into Rumpelstiltskin trying to get through to BCBS.

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    I do a lot of prosthetic eyes, I find BCBS of Mississippi to be the hardest entity to get money out of. They will "guarantee" payment in advance, then not pay or pay $300.00 on a $1500.00 bill. Often send the payment to the customer who cashes it and pays us nothing.
    Until recently they were paying a certian code on women and saying it was not applicable to men.
    They will disallow a claim for small things on the claimform and then when asked for advise on correction will disallow the coverage due to changes they advised you to do.
    I have a patient who was on thier board who said that the profits they have were due to disallowed claims.
    Some other states BCBS will pay well without problems.
    However I have had BCBS of Louisianna pay our claims to ocularist in Louisianna?
    Collecting from BCBS of Mississippi is usually more work than making the prosthesis, which isn't easy in itself.
    Chip

  4. #4
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    Getting paid by BCBS in Texas, Mississippi, and Louisiana

    Quote Originally Posted by happy lady;
    Does anyone else find this insurance the worst to get authorizations for? Most of the others are so easy, but with BCBS it takes so much time.
    Quote Originally Posted by chip anderson View Post
    I do a lot of prosthetic eyes, I find BCBS of Mississippi to be the hardest entity to get money out of. They will "guarantee" payment in advance, then not pay or pay $300.00 on a $1500.00 bill. Often send the payment to the customer who cashes it and pays us nothing.
    Until recently they were paying a certian code on women and saying it was not applicable to men.
    They will disallow a claim for small things on the claimform and then when asked for advise on correction will disallow the coverage due to changes they advised you to do.
    I have a patient who was on thier board who said that the profits they have were due to disallowed claims.
    Some other states BCBS will pay well without problems.
    However I have had BCBS of Louisianna pay our claims to ocularist in Louisianna?
    Collecting from BCBS of Mississippi is usually more work than making the prosthesis, which isn't easy in itself.
    Chip
    Happy Lady and Chip, things should get somewhat easier for you. A recent US Court of Appeals decision in the Fifth Circuit (applying to Louisiana, Mississippi, Texas) (Louisiana Health Service and Indemnity Company d/b/a Blue Cross and Blue Shield of Louisiana vs Rapides Healthcare System, No. 04-31114) will obligate BCBS to drop some disingenuous payment tactics that it has used for years.

    In part, BCBS will no longer be able to refuse to send payment to providers when the patient has signed an assignment of benefits form. Where previously BCBS has sometimes sent payment to the patient (and you get the situation Chip describes), now they will have to send payment to the provider. And if they do send payment to the patient either intentionally or by mistake that will not relieve them of any obligation to pay the provider too. In other words, they cannot say they will be paying twice.

    For some time BCBS in Louisiana has been flaunting the Louisiana assignment of benefits regulation [LA. REVISED. STAT. ANN. section 40:2010 (2004] that stated payments were to be sent to the provider if the patient requested such to be done. Now the Court has told BCBS "no more."

    BCBS tried to hide behind ERISA, but the Court told BCBS that ERISA does not apply in this case.

    Check with your state society. They should know about this and be able to give you additional information and guidance.

    Gil Weber, MBA

  5. #5
    OptiBoardaholic a1vo's Avatar
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    My experience w/ BCBS was back in 2003. It was BAD just like Happy and Cips said.

    Since then, I changed job and no longer have to deal w/ BCBS directly.
    Paul @ Silicon Valley California

  6. #6
    Bad address email on file fvc2020's Avatar
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    I guess I'm lucky. When working with BCBS of Minnesota it's a piece of cake. Now if you're referring to Illnois, California, or New York..GOOD LUCK:angry:

    My time I spend with BCBS of Minnesota usually is trying to fix out of state claims that we are given incorrect information about. I can't complain too much since the associates really try to help.

    christina

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