Anthem Out Of Network

[AGOG]

Is anyone affected by this?
https://www.cnn.com/2019/03/01/health/anthem-insurance-payments-patients-eprise/index.html

[Michele]

No.  I hadn't even heard it but I do not watch CNN.

[AGOG]

Our Facility is out of network. We are having the same issue. Actually, there is one litigation going on against one patient who took all the money and never paid anything to the facility. It is bad how the BCBS didn't accept a signed assignment of benefit from us. Paid all our patient the check on the subscriber's name.

[Michele]

I have seen this issue many times with out of network facilities.  That is why most collect from patient up front.  In many cases a family member puts out the money and then the patient gets the payment from the insurance. 

[PMRNC]

It never amazes me how many billers do NOT know ERISA even when over 85% of the claims they bill are ERISA.

With ERISA the claim is the patient's claim.. it's NOT the providers claim. If you are OUT of network you have two choices when dealing with ERISA. Do an ARF OR collect full payment at time of service. Insurer's such as BCBS have won lawsuits saying they do NOT have to honor an assignment of benefits for non par providers. HOWEVER if it's an ERISA plan and you have the Proper ARF (Authorized Representative Form) you can get paid or appeal on behalf of patient.