Author Topic: BCBS PAYMENTS , I NEED HELP  (Read 779 times)

Msladyajw

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BCBS PAYMENTS , I NEED HELP
« on: December 08, 2021, 02:14:24 PM »
I am a mass immunizer, I submitted claims to BCBS for covid testing, They paid 13.00 .. This does not even cover my hard cost, What can I do

Michele

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Re: BCBS PAYMENTS , I NEED HELP
« Reply #1 on: December 10, 2021, 10:31:31 AM »
It's impossible to answer based on your information.  What codes are you billing?  You said you are a mass immunizer, but then stated you submitted claims for testing.  Are you billing for vaccinations or testing?
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kristin

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Re: BCBS PAYMENTS , I NEED HELP
« Reply #2 on: December 12, 2021, 04:06:37 AM »
If you are a BCBS participating provider, you should have requested a copy of their fee schedule, so that you can compare the codes you billed as to what their "allowed amounts" are.

It could be the wrong code(s) was billed as you say you are an immunizer, then you say you billed for testing. Two different things. 

Or, it could be you billed the correct codes, but the BCBS allowed amounts for what you have billed are less than your costs. This is part of being a participating provider. If this is the case, you can try to renegotiate your fee schedule with BCBS, but this is pretty hard to do.

Msladyajw

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Re: BCBS PAYMENTS , I NEED HELP
« Reply #3 on: December 19, 2021, 08:58:39 PM »
First let me say thank you to both of you, I apologize for not being clearer I am so frustrated.

I own 4 clinics in the Phoenix Tucson area. We started this business performing criminal background and other pre employment services working with Dept of Transportation for Trucking companies and providing consortium services. This is a federal regulation where Truck drivers get pulled at random to report for drug testing, We never had to deal with insurance companies.
Because each company is responsible for all testing,

This is why we have the clinics, We perform Drug testing. When Covid hit companies started demanding covid test to return to work. Since this is an employment service we added it as a service.  We only conduct covid testing at a our clinic locations. We repeatedly got phone calls regarding covid testing that did not pertain to employment. SO I did all the required steps obtained NPI CLIA waiver etc. And started providing testing not pertained to just employment.

At the same time I had a mobile vaccination clinic built, And registered as a mass immunize. I am aware of the cost that can be billed for the vaccine, Actually its for administering because we cant charge for vaccine itself.

I am not an in network provider . I have no problem with the amounts paid for giving the vaccine. My issue is with the 6.00 paid for the test. Sometimes its 13.00 they pay sometimes its 6 they pay. Anyone here knows unlike vaccine that has no cost to provider. The same is not true with the test. and 6 dollars nor 13 covers the cost we pay for the test.

Th cares act states insurance companies must pay the cash price listed on provider website, I know a lot of places have taken this way to far charging up to 400 dollars for a test, I am not trying to do all that, But I cant very well pay more for a test than what I am getting reimbursed. I am not understanding why a few claims were paid the full asking amount saying not a network provider and not obligated to their pay rates, But then others and most pay either the 6 or 13. when all the same codes 87811 with a qw modifier is on every claim

Michele

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Re: BCBS PAYMENTS , I NEED HELP
« Reply #4 on: December 21, 2021, 03:25:13 PM »
Is any company paying more than $13?  I have not billed for any testing, however when I look it up it appears the going rate is $41.38.  Have you tried contacting any of the carriers to find out why the reimbursement is so low?
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Re: BCBS PAYMENTS , I NEED HELP
« Reply #4 on: December 21, 2021, 03:25:13 PM »