Medical Billing Forum

General Category => New! => Topic started by: johnnyhave on September 05, 2014, 05:29:35 PM

Post by: johnnyhave on September 05, 2014, 05:29:35 PM
The program with BCBS is of no value to Providers.  Our agency was told that the ParPlan would increase client flow.  In three years time we have not had a single referral.  The ParPlan terms limit what a Provider is actually paid by the language of the definitions.  Our experience has been to sign up under a pretense that we would get referrals only to have our rate cut to 1/4 because of contract language.  Without ParPlan, BCBS would be forced to pay the out of network benefit AND the client could be billed for the remainder.  In the ParPlan not only is the reimbursement rate cut to shreds but the client cannot be billed the remainder according to the terms.
Also,  when we went to terminate the contract (claiming breach), we were told that we had to stay another 30 days.  We instructed that everything had to be submitted by first class mail...LOL, when the contract was initiated by fax....
It seems by legal terminology this would be called ENTRAPMENT...

READ your contract,you will see Article 1 A and Article 1 C,then your next wise action might be to terminate their nonsense.
Post by: PMRNC on September 05, 2014, 06:54:20 PM
Did you read the contract before signing it? I've NEVER had a provider PAR with BCBS and not receive referrals from it.. Yes sure there are glitches but overall cancelling or opting out of BCBS would cut out more than 75% of most practice patient's.   As long as your willing to TAKE payment up front from BCBS patients .. shouldn't be a problem. They don't reimburse or accept assignment from non par providers.

Post by: johnnyhave on September 05, 2014, 07:46:30 PM
Perhaps it is different in Texas...?  It has been explained that we did not have to be in the PARPLAN to receive reimbursement.  We do have a payer number. So we shall see. 
We are an Outpatient Facility perhaps that is the referral problem...don't know. 
What we do know is the lack of service, seeming deceit, no referrals, and much lower reimbursement than any other Insurance Company.  At this time we will take our chances, since we have nothing to loose.

And of course we read the contract :) :) :) as well as asked for understanding of such numerous times with regurgitated ambiguities for answers....  >:( >:( >:(

Be Well!
Post by: PMRNC on September 06, 2014, 01:24:23 PM
yes there are states who have assignment of benefits laws except where ERISA law preempts :)