CMC and “Balance Billing” Oh The Pain of it all! – Your opinions!

[TheEmissary]

Originally Posted by FrankTheTank2

So what if I need to take my wife to the ER today? What should I do or ask to make sure this does not happen?

Well, if you took your wife to the emergency room where I went, and you had BCBS, you'd end up having a bill to pay. Every doctor who works in the ER, is in this doctors' group. So for BCBS patients, there is no alternative than to seek another hospital where ER doctors accept BCBS. There might be an insurance plan that the ER doctors group accepts, but BCBS isn't one of them. The non-acceptance of BCBS affects a wide swath of patients, because it's the biggest insurer of NC patients.

[brokensky]

But the way it is supposed to work - the doc should reduce his fees to accept whatever the usual and customary charges are, so it is not supposed to be a big deal as to whether or not your insurance covers the doc's services or not.

Just think - if, when you had called that doc's practice, someone had said - send us documentation from your insurance company - we will accept their determination of usual and customary charges - this would all be over.