I'll call this "why do people hate their health insurance carriers" and be done with it. The villian here is Blue Cross Blue Shield ....better known as "we may be stupid but it's policy".
My wife had two outpatient procedures, both required anesthesia. She didn't pick the anesthesiologist, just the doctor who performed the procedures at his outpatient clinic. So we get this bill from the knock 'em out docs for about 3 grand as BCBS won't pay anything as the procedures weren't done in an approved place although the docs were approved and the anesthesiologists, whom we didn't pick or have any say about, were out of network although our health care plan says we can go to anyone.
So I call the nitwits at BCBS who explained to me how everything was being applied to out "out of network" deductible. As we don't have a network I thought that was interesting. But the real problem was that the clinic where these procedures took place was not approved although it was an extension of the Dr.'s office.
So I trudged up the the notification sent to BCBS a week before by the doctor explaining to BCBS the where and who. Yes BCBS had that but they didn't specifically approve the location, and wanted it done in the local Long Island hospital rather then the clinic (at about 5x's the cost mind you).
So this is why I hate BCBS. 8 months ago BCBS stopped partnering with the 3 hospitals that service the east end of Long Island. They won't pay them until a contract for payments is reached and as I follow this through my old local online paper i find that BCBS is about 6 months late in payments submitted and they pay - now get this - at the last rate which was 2001. So they pay 180 days late and at 55% of what the hospital submits.
I'm sure glad there is no need for health care reform. Friggin' nitwits.
My wife had two outpatient procedures, both required anesthesia. She didn't pick the anesthesiologist, just the doctor who performed the procedures at his outpatient clinic. So we get this bill from the knock 'em out docs for about 3 grand as BCBS won't pay anything as the procedures weren't done in an approved place although the docs were approved and the anesthesiologists, whom we didn't pick or have any say about, were out of network although our health care plan says we can go to anyone.
So I call the nitwits at BCBS who explained to me how everything was being applied to out "out of network" deductible. As we don't have a network I thought that was interesting. But the real problem was that the clinic where these procedures took place was not approved although it was an extension of the Dr.'s office.
So I trudged up the the notification sent to BCBS a week before by the doctor explaining to BCBS the where and who. Yes BCBS had that but they didn't specifically approve the location, and wanted it done in the local Long Island hospital rather then the clinic (at about 5x's the cost mind you).
So this is why I hate BCBS. 8 months ago BCBS stopped partnering with the 3 hospitals that service the east end of Long Island. They won't pay them until a contract for payments is reached and as I follow this through my old local online paper i find that BCBS is about 6 months late in payments submitted and they pay - now get this - at the last rate which was 2001. So they pay 180 days late and at 55% of what the hospital submits.
I'm sure glad there is no need for health care reform. Friggin' nitwits.
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