"Charges not covered"

[REWahoo]

Take the complaint back to BCBS. Docs can't do this.

I agree. Maybe someone with first hand knowledge will chime in, but I thought the agreements with BCBS, etc. required docs under the agreement to accept the contract amount.

 

[KB]

If the provider is a BCBS provider, he signed a contract with BCBS to accept the BCBS allowed amount or negotiated amount (less any copay or deductible) as payment in full.

If the provider does not follow the contract they signed, contact your BCBS and let them know. They should contact the provider and remind him of his contract, and tell him what he needs to accept on your claim. If the provider continues to be a problem, their Provider relations department will most likely contact him.

 

[Jonathan Pletzke]

Who can help?

If the provider is a BCBS provider, he signed a contract with BCBS to accept the BCBS allowed amount or negotiated amount (less any copay or deductible) as payment in full.

If the provider does not follow the contract they signed, contact your BCBS and let them know. They should contact the provider and remind him of his contract, and tell him what he needs to accept on your claim. If the provider continues to be a problem, their Provider relations department will most likely contact him.

This is a tough one.

The insurer appears to be following the rules, so you can't complain to the department of insurance, although they might be able to tell you who to complain to. To find your state department of insurance, you can go to: National Association of Insurance Commissioner's Link to Your State Insurance Department Site. I've got a quicker list to find your department of insurance's health insurance section - if I knew your state or somebody asks for a link I can post it.

The state medical regulators are more concerned with quality of care than billing practices, so that might not be a good course.

The insurer can put pressure on the provider, but can't prevent them from putting your account to collection (incorrectly in my opinion). You can win a lawsuit or counter lawsuit, but then who do you end up getting medical care from?

Perhaps this is a bigger issue in your area, since you state that there were 3 different providers (different offices?) with the problem. The last thing that comes to mind is the state attorney general who may find some practice that is going wrong and can make a difference.