Author Topic: Blue Cross question  (Read 2232 times)

alaughlin

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Blue Cross question
« on: January 14, 2010, 01:52:11 PM »
 I bill for a physical therapy office. We are not providers with Blue Cross and we have a patient with two Blue Cross policies.  The first policy only paid $25.00 a  visit so i billed the secondary BC.  Secondary paid $0 with the explantion "because the member's primary carrier has a negotiated discount with the provider, this amount is not the member's respnsiblity to pay."  We do not have a contract with Blue Cross so my question is can I still bill the patient???  Any help would be greatly appreciated.  Thanks.

Pay_My_Claims

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Re: Blue Cross question
« Reply #1 on: January 14, 2010, 03:57:54 PM »
did you not call bcbs about the denial code? If you are non par why are you getting that denial?

Michele

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Re: Blue Cross question
« Reply #2 on: January 14, 2010, 06:12:22 PM »
I agree with Charlene, I would call to make sure it was processed correctly.  If processed correctly, if you are not par you are entitled to bill the patient.

Michele
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dfranklin

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Re: Blue Cross question
« Reply #3 on: January 25, 2010, 03:40:11 PM »
I had this happen to me. My provider told me he was not PAR with any carrier when I first signed him up. Then I started getting these type of denials and reductions and found out he was PAR with several.  Now when I bring on a provider I call the major carriers and ask if they are PAR or not.  If you are Not Par then as Charlene and Michelle both stated you should not be getting that type of denial and you should be able to bill the patient.

PMRNC

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Re: Blue Cross question
« Reply #4 on: January 26, 2010, 11:43:07 AM »
A lot of providers don't read their contracts. For example, BCBS is actually one that could be difficult to get out of, they have rules on how to opt out, waiting periods, etc. One of my providers had a 2 year wait in his contract because he didn't bother to read it before signing it. So when he opted out, he had 2 years stuck in their network. This means a lot of times doctors think they GOT out but again, without knowing the contract opt out clauses they could be stuck and not know it. I've also seen many providers not even know they are par with a carrier.  :o
Linda Walker
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alaughlin

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Re: Blue Cross question
« Reply #5 on: January 28, 2010, 03:25:36 PM »
Thank you all for responding.  I called Blue Cross and they are going to re-process the claims....but I'm not real hopeful that they will pay anything.

PMRNC

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Re: Blue Cross question
« Reply #6 on: February 03, 2010, 08:44:38 PM »
hmm make sure the EOB doesn't indicate the pmt went to the patient. If you are non par they won't honor assignment.. take another look at EOB to make sure, maybe you missed it?
Linda Walker
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alaughlin

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Re: Blue Cross question
« Reply #7 on: February 10, 2010, 10:22:04 PM »
 :) Success!!!  The patient's secondary BC paid their portion. What a pleasant surprise.

Csinsay

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Re: Blue Cross question
« Reply #8 on: February 18, 2010, 03:09:10 PM »
Hi Alaughlin,

When you called the secondary, Blue Cross, what was your justification to them on why it should be re-processed?  Also,  how much did the secondary finally end up paying? 

Thanks,
Conrad

alaughlin

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Re: Blue Cross question
« Reply #9 on: February 24, 2010, 05:09:19 PM »
Conrad, I told them we were not in-network so how could we have a negoiated discount with them.  Also, they paid everything that primary did not.  Hope this helps. :)