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

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thatcuteblonde:
Believe you me, I hear you on the verifying. Unfortunately, I came into the scenario here a bit late and the 'office manager' i.e. glorified title given to a woman with basic clerical skills and no knowledge of billing, has been doing the verifications. I have run into numerous problems with the half, um, tail, way she has been doing so.

I found out the services are not excluded in the policy provisions however the codes for MUA are in the surgical section of the CPT book therefore as a chiro they are denying as outside the scope of this license, however here in IL he is licensed to do so. I called to verify benes afterwards and was told it wasn't listed as an exclusion and that we'll have to appeal, I was just curious as to the best method of presenting our case.

Michele:
Good luck with the appeal.

Michele

midwifebiller:
I would have the member go to their HR department and complain.  If HR will advocate for the member and contact their BCBS plan, there is a much greater chance of an appeal being honored.

~Kelli

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