Medical Billing Forum

Billing => Facility Billing => : Nick D September 13, 2019, 02:56:37 PM

: Blue Cross Low Payments
: Nick D September 13, 2019, 02:56:37 PM

This year I've noticed a huge dive in "home plan" pricing for Substance Abuse DTX and RTC. The once dreaded local rates (Florida for me) are now much more desirable. BCBS Illinois being the worst of the drops. Has anyone figured out a clean and proven tactic for getting paid higher on BCBS claims?

i.e BCBS IL XOF prefix used to pay 100% of billed now pays $450 or lower per day  >:(

: Re: Blue Cross Low Payments
: Michele September 15, 2019, 06:24:38 PM

I'm assuming from other posts that you are OON?  Did you call to see why they changed?

: Re: Blue Cross Low Payments
: Nick D September 16, 2019, 04:50:05 PM

We're OON and I've called more than a few times. Florida Blue simply states that Homeplan pricing was applied. We can go through the appeals process yet it's usually unsuccessful. Just wanted to see if anyone else found a better way.

: Re: Blue Cross Low Payments
: Michele September 17, 2019, 09:51:16 AM

Being out of network has it's advantages and disadvantages.  One of the disadvantages is that they won't give you a lot of information about claims.  Of course you can charge the patient the full charge, but as most OON providers do, you are trying to get the patient the best reimbursement possible.