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Old 01-03-2011, 04:54 PM
 
Location: Raleigh, NC
2,538 posts, read 4,673,652 times
Reputation: 2590

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Quote:
Originally Posted by lamishra View Post
That's weird, we had BCBS for 10 years up until this year and never had a single issue with them denying anything! OP, are you sure you're doing everything within the parameters they set? Such as free yearly mamograms after a certain age? Or that your provider is submitting the information correctly? They always covered all of our preventative medicine as long as we were following the standard procedures.
I've also had BCBS for 10 years and only had a problem once. All my routine things are covered, but when I had a complicated pregnancy without maternity I had to fight to get them to cover it. The policy stated that if there were a life-threatening complication that they would cover it under my regular coverage. I've always chosen to go without the rider because of that. It has actually worked out to cost more to get the maternity coverage because of the waiting period...paying all those months waiting to get pregnant. And I've always had uncomplicated pregnancies until the last one. It took me a year to get them to pay the bill for the life-threatening complications. It almost went to collections...actually it did a couple times but I kept fighting and eventually BCBS covered it.
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Old 01-03-2011, 05:21 PM
 
9,680 posts, read 24,046,903 times
Reputation: 4130
We have Federal Employees BC/BS.

No problems as long as you use preferred providers and facilities.
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Old 01-03-2011, 05:48 PM
 
Location: Cary, NC
2,932 posts, read 6,883,160 times
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BC/BS coverage depends on the plan group you're subscribed to. You cannot really compare your bc/bs of nc plan with another person's unless you have the same exact group code or employer. Like someone else said, sometimes insurances will deny a claim to see if the MD will actually appeal the denial. It happens a lot for medications but also happens for procedures. See if you're MD's billing department can look into it. Also make sure they are using the "correct" billing and procedure codes. Also look at the denial to see the exact reason why they denied the claim.
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Old 01-04-2011, 05:08 AM
 
682 posts, read 1,130,828 times
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90% of claims being denied are due to the doctors office billing incorrectly.

Sometimes you have to take the extra step to avoid problems with insurance companies. When you go in for your annual exam, and the doctor says "do you have any problems you want to discuss", say NO. Once you say YES, it turns into a diagnostic visit and will no longer be billed as a routine exam. When you need tests like a mammogram or colonoscopy as part of your routine exam, do NOT have it done at the hospital or chances of it being billed as diagnostic go way up....go to a free standing facility for these services.

Last edited by Green Irish Eyes; 01-04-2011 at 08:08 AM.. Reason: Deleted off-topic comment
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Old 01-04-2011, 05:35 AM
 
Location: Durm
5,850 posts, read 8,790,024 times
Reputation: 6572
Quote:
Originally Posted by quietstormnc View Post
90% of claims being denied are due to the doctors office billing incorrectly.
So true. I don't have BCBS but I've had to appeal things billed incorrectly at Duke numerous times. It's maddening because one bill was nearly $400 and it took two appeals AND several messages for the physician herself to sort out the coding error (finally did). It's scary because I think of someone like my elderly grandmother who wouldn't even know to do this and would end up paying it. Appeal, appeal, appeal...
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Old 01-04-2011, 07:14 AM
 
595 posts, read 1,697,013 times
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Another angle to look at is to make sure that your provider is processing your claims to your carrier with the correct coding. Screening services have specific Diagnosis (ICD-9 code) and CPT (Procedure code) that are to be used. Check with your provider of care and make sure that screening codes are/were used.
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Old 01-04-2011, 12:52 PM
 
804 posts, read 1,793,144 times
Reputation: 749
Quote:
Originally Posted by quietstormnc View Post
90% of claims being denied are due to the doctors office billing incorrectly.

Sometimes you have to take the extra step to avoid problems with insurance companies. When you go in for your annual exam, and the doctor says "do you have any problems you want to discuss", say NO. Once you say YES, it turns into a diagnostic visit and will no longer be billed as a routine exam. When you need tests like a mammogram or colonoscopy as part of your routine exam, do NOT have it done at the hospital or chances of it being billed as diagnostic go way up....go to a free standing facility for these services.
this.

i had bc/bs for about 4 years & only had one issue with it, which actually was the doctor's office's screw-up in how they coded. i now have united healthcare but wish i had bc/bs again as i feel that i have had more issues with uhc than bc/bs.

anytime i'm going in for anything other than a routine physical that i know is covered, i always call my insurance company in advance & confirm what is covered & how it should be coded/reported to the insurance company to ensure coverage. i'd give bc/bs a call & ask them to explain why it was denied if you understand it was a covered procedure.
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Old 01-06-2011, 01:45 AM
 
6 posts, read 9,789 times
Reputation: 14
Quote:
Originally Posted by quietstormnc View Post
90% of claims being denied are due to the doctors office billing incorrectly.

Sometimes you have to take the extra step to avoid problems with insurance companies. When you go in for your annual exam, and the doctor says "do you have any problems you want to discuss", say NO. Once you say YES, it turns into a diagnostic visit and will no longer be billed as a routine exam. When you need tests like a mammogram or colonoscopy as part of your routine exam, do NOT have it done at the hospital or chances of it being billed as diagnostic go way up....go to a free standing facility for these services.
Yes, I do all those things and still have problems with BCBS paying. I also go to free standing facilities you mention. Traveling an hour and a half for a stress test is one thing, taveling an hour and a half for a colonoscopy is another after a night of prep.
I bet the top dogs at BCBS don't have to worry about this.
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Old 01-06-2011, 03:27 AM
 
682 posts, read 1,130,828 times
Reputation: 776
Quote:
Originally Posted by Silence Goodall View Post
Yes, I do all those things and still have problems with BCBS paying. I also go to free standing facilities you mention. Traveling an hour and a half for a stress test is one thing, taveling an hour and a half for a colonoscopy is another after a night of prep.
I bet the top dogs at BCBS don't have to worry about this.
Im sorry you are having these problems but dont think that BCBS is the only carrier that has problems like this. Most of the other carriers are a lot worse.
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Old 01-06-2011, 03:07 PM
 
6 posts, read 9,789 times
Reputation: 14
Quote:
Originally Posted by quietstormnc View Post
Im sorry you are having these problems but dont think that BCBS is the only carrier that has problems like this. Most of the other carriers are a lot worse.
Thank you. I just wish I had some other carriers from which to pick.
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