How do you find out if a Doctor is "in-network" on Bluecross/Blueshield?

[Trumplestiltskin 5,791]

They have the information.

They just aren't going to tell you what they have in their files today.

Because the claim will be paid on information relevant on the day of service.

What's the difference? How often do doctors join and leave networks?

What are the chances of your doctor being in-network today and out-of-network two weeks from today?

Often.

A doctor can 'leave' a network simply by changing the facility he works in. For example, he may be a BCBS provider working for BCBS approved Hospital A. He leaves to go to BCBS Hospital B. He still has to be re-credentialed before BCBS will pay claims for services rendered by him at Hospital B.

And it doesn't matter what the odds are. It happens.

I can't help it if it doesn't make sense.

Claims are paid based upon conditions on date of service. This includes the terms of the contract, premium payment and eligibility. And a host of other factors.

Rebecca is right. I also work with insurance claims/billing, and when I call to verify benefits, I always have to listen to their disclaimer recording that says benefits quoted are not a guarantee of payment. Which I agree is totally retarded. Why am I calling to check benefits if they aren't necessarily correct? I actually 'verified' benefits on a patient, was told she had 20 visits for the calendar year. She came for 10 before we got our first EOB back stating she didn't have acupuncture benefits!!! Unfortunately the patient is stuck with the bill because the contract is between them and the insurance, not between us and them and us and the insurance. And that creates bad will between the patient and doctor. I agree that it sucks though. For all concerned, except of course the insurance company.

It certainly makes a person apprehensive about seeking medical care. I thought my friend in CA was crazy for checking himself out of the hospital after suffering a stroke. Having to deal with this sort of #######, you can sort of understand it.

Its criminal that we have a system that system makes people so afraid of participating for fear of financial financial ruin that they'll take big risks with their health just to avoid it.

Edited November 3, 2009 by Gene Hunt

[w¡n9Nµ7 §£@¥€r 123]

Its criminal that we have a system that system makes people so afraid of participating for fear of financial financial ruin that they'll take big risks with their health just to avoid it.

The only thing criminal here is YOU!

Medicare providers aren't 'big government'.

Says the big-government liberal!

[Mr. Big Dog 10,747]

Its criminal that we have a system that system makes people so afraid of participating for fear of financial financial ruin that they'll take big risks with their health just to avoid it.

Certainly. And we've got 45,000 deaths annually that are attributable solely to the fact that people cannot afford to get the care they need to live. That's a 122 people that will die today, 122 more tomorrow, another 122 the day after that and so on. 122 lives lost each and every day for nothing but the inability to afford the care to live. It's a shame, really.

[w¡n9Nµ7 §£@¥€r 123]

Its criminal that we have a system that system makes people so afraid of participating for fear of financial financial ruin that they'll take big risks with their health just to avoid it.

Certainly. And we've got 45,000 deaths annually that are attributable solely to the fact that people cannot afford to get the care they need to live. That's a 122 people that will die today, 122 more tomorrow, another 122 the day after that and so on. 122 lives lost each and every day for nothing but the inability to afford the care to live. It's a shame, really.

You know what happens to a forest if you don't let the deadwood burn?

No, I guess ya don't! In librul utopia aka fantasy land... that don't happen. But this is the real world!!!!!

[Krikit 1,166]

Would you believe I just got off the phone with the insurance company over a nice fat bill I found in my mailbox just now.

$410 for routine bloodwork

So I call the insurance guy who tells me that he has to call the lab to find out what's going on and call me back tomorrow.

I get enough of this paper-pushing jobsworth bullsh!t at the office - I could do without a dose at home too!

Why on earth can this stuff not be done transparently - why does the patient need to be dragged into this?

I agree. I went to my very first American doctor last month. He told me to give blood to the blood bank because they will perform the blood tests for free. If he did it he would have to charge me for them. The blood bank doesn't want my blood because I've spent too much time in England.

My in-network doctor works at a hospital that is not a "preferred hospital" for my insurance company. It is not "out-of-network," it is just "not preferred," which means it is a little more costly than the "preferred hospital" where my doctor does not have privileges... i'm learning all this as i go along... and if i sound confused it's because i am!!

Aye yai yai. I guess I'm going to have to ask that question of someone. I wonder who I ask?

For our baby's delivery, i don't know who the H#ll wrote down for our insurance "medicaid pending" (instead of BCBS). Because they didn't record our insurance information correctly, I've had to talk to each of the doctors that saw us during the hospital stay to correct their mistake . Another great one: When the actual hospital filed their claim, they filed our son's name, with my birth date, and my husband's SS# (I think that employee deserves a round of applause! )

On the serious side..... that is ridiculous.

[Mr. Big Dog 10,747]

Its criminal that we have a system that system makes people so afraid of participating for fear of financial financial ruin that they'll take big risks with their health just to avoid it.

Certainly. And we've got 45,000 deaths annually that are attributable solely to the fact that people cannot afford to get the care they need to live. That's a 122 people that will die today, 122 more tomorrow, another 122 the day after that and so on. 122 lives lost each and every day for nothing but the inability to afford the care to live. It's a shame, really.

You know what happens to a forest if you don't let the deadwood burn?

No, I guess ya don't! In librul utopia aka fantasy land... that don't happen. But this is the real world!!!!!

Well, if the goal is to clear the forest from dead wood, then the system fails as well. Surely, there's more dead wood than what is being cleared.

Edited November 3, 2009 by Mr. Big Dog

[Danno 1,228]

Really this subject is tribute to how a non-issue can actually get so many responses.

Pike Click

http://www.fepblue.org/provider/index.html

you should have your answer within 4 minutes (call to make appointment included.).... a lot less time than you have spent posting about this topic.

[Trumplestiltskin 5,791]

So I just got the call back from the insurance company about the $410 bill I received yesterday.

"It looks like they have your insurance information down incorrectly, so you will receive a new bill".

"any idea how much it will be?"

"Nope"

Priceless.

[Trumplestiltskin 5,791]

Really this subject is tribute to how a non-issue can actually get so many responses.

Pike Click

http://www.fepblue.org/provider/index.html

you should have your answer within 4 minutes (call to make appointment included.).... a lot less time than you have spent posting about this topic.

I have access to a provider list Danno.

My question is why noone can tell me with any degree of definite certainty whether the physician is covered as "in-network".

[Magnolia31 0]

So I'm trying to find a doctor on my insurance website - I've pulled up a list of providers near to my work and found one within a half-mile of here but for some reason I can't seem to find out from the insurance people if the person is covered as "in-network".

The customer service rep I spoke to apparently tried to call the provider but couldn't get through and told me to ask them if they are "contracted to the local bluecross/blue shield".

Is this really how these things are done - something that could mean my paying a co-pay at 100% coverage Versus 50% against a deductible is based entirely on my taking someone's word for it that they are covered!?

How can the insurance company not provide a straight answer as to who is covered under a plan? I mean... what is it exactly I'm paying them for if not to have this sort of information so that informed decisions can be made!?

When making an appointment with a physician from this directory, confirm with the physician before you receive treatment that he/she is participating in a Blue Cross and/or Blue Shield plan.

In order to receive benefits, services must be covered under the terms of your contract. The services to which you are entitled may not include every specialty offered by the providers listed in the directory. Please call the Customer Service telephone number on the back of your ID card to determine which services are covered.

Empire BlueCross BlueShield cannot and does not guarantee or warrant that files available for downloading from this site are free of viruses or codes that have destructive properties.

Empire BlueCross BlueShield and other Blue Cross and Blue Shield Licensees have made reasonable efforts to validate that the list of providers displayed is up to date and accurate. Please call the provider prior to scheduling an appointment to verify that the provider continues to be part of the network. Neither Empire BlueCross BlueShield, the Blue Cross and Blue Shield Association nor any of its Licensees shall be liable for any losses, damages, or uncovered charges as a result of using this provider locator Web site or receiving care from a provider listed in this Web site.

We used to have BCBS as well and all i did was go to their website and click on "Find a Provider" .... You can then choose a specialty, etc. and it will only give you a list of providers that are in their network.

[Trumplestiltskin 5,791]

That's fine if you want to take on trust that the list contains up to date information (it doesn't). I'm just amazed that when you call the insurance company to clarify that the physician is currently in-network, that you can't get a better answer than "Maybe. Maybe not".

Edited November 3, 2009 by Gene Hunt

[rebeccajo 14]

Really this subject is tribute to how a non-issue can actually get so many responses.

Pike Click

http://www.fepblue.org/provider/index.html

you should have your answer within 4 minutes (call to make appointment included.).... a lot less time than you have spent posting about this topic.

I have access to a provider list Danno.

My question is why noone can tell me with any degree of definite certainty whether the physician is covered as "in-network".

That's Fed Blue Cross. Is that appropriate for 6?