Blue Cross Low Payments

[Nick D]

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 

[Michele]

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

[Nick D]

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.

[Michele]

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.