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BCBS out of state plan denying what's covered by our local BCBS. Help!

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thatcuteblonde:
My doc has billed for an MUA (Manipulation Under Anesthesia) where we are located (IL). The patient's BCBS plan is through Alabama and has denied the services indicating they can't be done by a Chiropractor, however through Blue Cross of IL it is allowed and payable. He is licensed in the state of Illinois to render these services. Has anyone had any experiences like this or does anyone have any advice/suggestions on appealing this denial?

The patient had three of them prior to us receiving the denial, so there is a $15k bill! Any help will be greatly appreciated.

Pay_My_Claims:
Unfortunately, my experience won't help you in a way you need it. I have had several claims for BCBS for DME in which certain things are considered "non covered" by the clients policy, but are covered by our local BCBS. It would all be determined on the individuals plan.

Michele:
A little late to ask, but did you call to verify benefits on the patient's plan before the services were rendered?  If so, what were you advised? 

You can try to appeal by including information showing that the services are allowed and covered in IL, but I'm not sure if it will make a difference.  I would write up an appeal letter, include that info and try it.  It's obviously worth the effort.

Good luck

Michele

PMRNC:
If the service is not covered in the underwriting state (Alabama) then it will not be covered.  Coverage is determined by the location of the plan and where it was written.

Pay_My_Claims:

--- Quote from: PMRNC on May 18, 2009, 08:35:55 PM ---If the service is not covered in the underwriting state (Alabama) then it will not be covered.  Coverage is determined by the location of the plan and where it was written.

--- End quote ---

FIRST rule of billing VERIFY VERIFY VERIFY

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