Minor Medical Clinic Insurance Issue

[littleb]

We went hiking while traveling and I fell and gashed my hand on a rock and also hit my head on the ground. I wanted to make sure my head injury was minor so I called around to find a minor medical clinic that was in network with BCBS. The 2nd facility I called stated they were in network so that is where I went for treatment.

Fast forward 5 months and I received a bill from the clinic processed by BCBS as out of network (10,000 deductible).

I called the facility and asked for the Manager to explain how they misled me when I called and when I gave them my insurance card. (I asked twice)
I got a young girl who said SHE was the manager (right....) so I explained how they told me they were in BCBS network and my EOB was processed out of network. First she said they would not know if they were in my network. Wrong - I told her you always ask if facility or dr is in network before getting care. Then she said maybe someone at the clinic made a mistake. She said she would get with her Manager (I thought she was the manager ) and call me back.

She called me back and said her Manager said BCBS has been processing bills incorrectly lately. After hanging up I realized she did not ask for any of my billing information so how could they resubmit my claim?

I started researching online this Minor Medical Clinic and could not believe all the billing issues with this brand clinic. Very common for them to take your insurance and tell you they are in your network. Also BBB website had many billing complaints with very few responses from the business. All locations in the US have a D- rating with the BBB . Also, you could not get anyone to help with billing issues or to correct billing errors. Deceptive business practices?

I called the number on my statement to pursue the billing issue. The billing department is located in another state. I waited on hold for 45 minutes, hung up and waiting another 25 minutes. You cannot get a human being but on the phone and their website they make it very clear how you can pay your bill. You cannot send them an email unless it falls under the Marketing Dept. or Franchise Info.

These brand Minor Clinics are popping up all over the country and I found out they are franchises.

So it looks like I will send a few letters out this week. Learned a valuable lesson here.

I was notified for 2019 BCBS with the ACA will no longer cover out of network benefits.

Maybe I need to stay at home.

 

[Walt34]

These brand Minor Clinics are popping up all over the country and I found out they are franchises.

Would you care to share the name of the brand of Minor Clinic so that others might be forewarned?

 

[CardsFan]

As a warning to others, I always check directly with BCBS, usually on line. Never had a problem, but I could just be lucky.

 

[littleb]

Would you care to share the name of the brand of Minor Clinic so that others might be forewarned?

American Family Care

Called BCBS and they not in network but rep told me to file an appeal. Don't know if BCBS will pay it but it is a start.

 

[MichaelB]

Consider filing a complaint with the state Attorney General and the state Insurance Commission. If either of those agencies get involved the clinic may agree to accept your insurer’s in-network reimbursement.

 

[MRG]

American Family Care

Called BCBS and they not in network but rep told me to file an appeal. Don't know if BCBS will pay it but it is a start.

I recently wore a holter monitor for a week. My provider said they checked my benefits and I was good to go. I while later I received a letter from Anthem saying I was an idiot for going to an out of network provider. They sent 12 pages of graphs to explain why I was an idiot , $6,500 they weren't covering.

I called the holter monitor provider and they said worst case, $225. They would write to anthem and appeal.

Last week I received my EOB, $85! I guess the appeal worked. I've only appealed one charge myself and I did win it.

 

[littleb]

Consider filing a complaint with the state Attorney General and the state Insurance Commission. If either of those agencies get involved the clinic may agree to accept your insurer’s in-network reimbursement.

I plan to send a letter to the insurance commissioner plus the BBB. I read more complaints about them where AFC turned them over to a collection agency and they never received a bill. The only bill I received from them was 5 months after date of service.

 

[ExFlyBoy5]

As a warning to others, I always check directly with BCBS, usually on line. Never had a problem, but I could just be lucky.

Very good advice. Granted, sometimes there just isn't time to actually verify, but if there is...this should be done every, single, time.

My DW sees an out of network neurosurgeon every 6 months. Due to the complexity of her issue, non of the in-network providers are suited for her care. Getting the out of network provider has been relatively simple, but a week before her appointment, we call to make sure the authorization is still good. It's a bit of a pain, but much easier than trying to deal with a very large bill.

 

[Silver]

I would never expect any health care facility/provider to know what insurance policies are within or outside of any "network". There hundreds of different insurance products, and frequent changes to coverage that would require a lot of time and effort to keep up. Individual providers are just not staffed for that work load, especially the smaller offices. Insurance companies only have their own products to keep track of, and they do it as part of their normal daily business.

Smart health care providers insist their staff tell callers to check with their insurance company to find covered facilities, and will not attempt any other definitive answer.

 

[travelover]

I would never expect any health care facility/provider to know what insurance policies are within or outside of any "network". There hundreds of different insurance products, and frequent changes to coverage that would require a lot of time and effort to keep up. Individual providers are just not staffed for that work load, especially the smaller offices. Insurance companies only have their own products to keep track of, and they do it as part of their normal daily business.

Smart health care providers insist their staff tell callers to check with their insurance company to find covered facilities, and will not attempt any other definitive answer.

I reject this line of thinking. This might have been an acceptable excuse prior to computers, but this information can easily be centralized and accessible by a clerk in Timbuktu. If you are going to be opaque in your pricing, you don't get to be wily in your insurance affiliation acknowledgements.

 

[Texas Proud]

My suggestion is to do what I do when this happens to me...


Ignore it.








You would be surprised how many places will fix what they did wrong if they do not get any money... this past year I have had probably 8 EOBs refusing to pay and ignored them all... no mention from my Dr or other facility....

 

[Crewer]

Years ago a friend of mine said that when she has to challenge a med facility bill, she has her attorney brother send the letter in such a way that they know it's an attorney sending it. I've never had the issue so don't know about that. In these days of social media the threat of a bad review often works as well for other things. A doctor friend of mine says it's coming to medicine. If reviews were easy to get to before you go to the clinic, then I suppose a few scathing reviews about billing and they might start to lose patients and would clean up their act.

Good luck.

 

[MRG]

I reject this line of thinking. This might have been an acceptable excuse prior to computers, but this information can easily be centralized and accessible by a clerk in Timbuktu. If you are going to be opaque in your pricing, you don't get to be wily in your insurance affiliation acknowledgements.

Actually it's impossible for some. When I signed up for a new plan this year I checked about providers I currently see.

Well they were in network but no one could find them. I mentioned I knew one doctor was, the rep says "no absolutely not"! Then she said "oh, maybe I have to use the other program to see him". Sure enough there he was, in a town he'd left 5 years ago.

At least one insurance company has a data model that Codd and Date would love. [emoji111]

 

[Sue J]

I would never expect any health care facility/provider to know what insurance policies are within or outside of any "network". There hundreds of different insurance products, and frequent changes to coverage that would require a lot of time and effort to keep up. Individual providers are just not staffed for that work load, especially the smaller offices. Insurance companies only have their own products to keep track of, and they do it as part of their normal daily business.

Smart health care providers insist their staff tell callers to check with their insurance company to find covered facilities, and will not attempt any other definitive answer.

When I called my insurance company to check if a provider was in network they told me to check with the provider.

I now check with BOTH!

 

[littleb]

I worked in health insurance benefits years ago and always told everyone to ask the dr or facility if they were in network. Dr`s can drop off or be removed from an insurance plan at any time and the insurance company directory may not be updated to reflect the change. This, of course, is almost impossible when dealing with a hospital and their out of network providers.

 

[joeea]

The lesson is: unless it is an emergency, check if a facility is in your health network yourself before seeking treatment.

 

[cathy63]

I plan to send a letter to the insurance commissioner plus the BBB. I read more complaints about them where AFC turned them over to a collection agency and they never received a bill. The only bill I received from them was 5 months after date of service.

What do you hope to accomplish by writing to the BBB? They are a non-profit which offers to help consumers and businesses negotiate a compromise after an unsatisfactory transaction. They have no authority to compel a business to engage in negotiations or respond to complaints. If a business is not interested in engaging with the BBB, as this one is clearly not given their D- rating, the BBB cannot help you.

 

[Texas Proud]

I worked in health insurance benefits years ago and always told everyone to ask the dr or facility if they were in network. Dr`s can drop off or be removed from an insurance plan at any time and the insurance company directory may not be updated to reflect the change. This, of course, is almost impossible when dealing with a hospital and their out of network providers.

My gripe is that the insurance company has zero incentive to keep that directory updated... I can tell you that my current insurance still has my old Dr from over a year ago still listed at her old address even though it was closed after being flooded...


When I was on BCBS I signed up for a primary care Dr. who had moved to another state 14 months (or so) earlier... and they still had her listed as a Dr 2 years later when I was looking to find another one...


On my current plan I called like 50 Drs to change my PCP... and all said they were no longer taking that insurance...

 

[zinger1457]

Would the payment for the service come out of your deductible even if it was in network? Not familiar with the clinic you used but the one I use has reasonable cash rates. In fact I found out the hard way after getting a cut stitched at the clinic that their cash rate for getting a cut stitched is about 1/2 the BCBS negotiated rate. Try and find out what the BCBS negotiated rate would be for the service and negotiate with the clinic down from there.