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

[Trumplestiltskin 5,791]

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.

Edited November 2, 2009 by Gene Hunt

[RebeccaAndPhil 5]

I usually have more luck calling the actual doctor then the insurance company. What I do is call the doctor's office and ask if they accept the insurance I have and if it's considered in network. They usually know and have never lied

[rsn 135]

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.

I also have BCBS. If you are using the tool on BCBS's website to find a provider, all providers listed should be in-network. The provider should also be able to confirm if they have an agreement with BCBS.

I've had mixed results with their doctor finder tool. Sometimes it comes up with 0 results when I know there are plenty of in-network doctors nearby.

[Trumplestiltskin 5,791]

Well its also "when" they are covered that's a problem - already been hit a couple of times with "Yes, they are in-network - but that only started from this date so for this visit you'll have to pay $XXXX"

[rsn 135]

Well its also "when" they are covered that's a problem - already been hit a couple of times with "Yes, they are in-network - but that only started from this date so for this visit you'll have to pay $XXXX"

Ouch. Gotta love insurance companies!

[Krikit 1,165]

*biting tongue*

[Trumplestiltskin 5,791]

I seriously don't understand all the hoop-jumping. I just got a call back from the Dr to say that they are covered but to check back with the insurance company on a couple of other issues that might prevent coverage from kicking in.

What a bunch of dirty shysters these insurance people are.

[Mr. Big Dog 10,747]

Ah the efficiency that private enterprise brings to the health care system. But at least you don't have to deal with goverment bureaucrats.

[Trumplestiltskin 5,791]

What gets me is that there's no way I could possibly know any of this information - there isn't a single place I can look and find out if the person is covered, when they started participating in the network or any of the potential issues that would prevent my insurance from covering the treatment.

So I'm left at the mercy of the word of the doctor and the customer service rep - and even then I can likely expect some billing foul-up that will require a bunch of my time to sort out.

[Mr. Big Dog 10,747]

What gets me is that there's no way I could possibly know any of this information - there isn't a single place I can look and find out if the person is covered, when they started participating in the network or any of the potential issues that would prevent my insurance from covering the treatment.

So I'm left at the mercy of the word of the doctor and the customer service rep - and even then I can likely expect some billing foul-up that will require a bunch of my time to sort out.

As they say: freedom isn't free.

[rsn 135]

What gets me is that there's no way I could possibly know any of this information - there isn't a single place I can look and find out if the person is covered, when they started participating in the network or any of the potential issues that would prevent my insurance from covering the treatment.

So I'm left at the mercy of the word of the doctor and the customer service rep - and even then I can likely expect some billing foul-up that will require a bunch of my time to sort out.

As they say: freedom isn't free.

I'm not sure how freedom is part of this at all.

[Trumplestiltskin 5,791]

Considering how pervasive and powerful the health insurance industry, they run their billing departments as if it was a cottage industry.

There's no transparency or clarity for what was billed vs. what is covered - and rarely does the website match up with the paper invoices I get in the mail.

[AlHayatZween 2]

It is terrible, you got that right...

Some success I've had recently is to e-mail customer service and get it all in writing, and then send it all back to them when they want to deny a claim. (This wasn't with BCBS tho... it was with a local insurance company.)

It sucks... i currently can't find out if my hospital is "out of network."

[Krikit 1,165]

It sucks... i currently can't find out if my hospital is "out of network."

You mean hospitals can be out-of-network, even if the in-network doctor has hospital privileges?

[Mr. Big Dog 10,747]

What gets me is that there's no way I could possibly know any of this information - there isn't a single place I can look and find out if the person is covered, when they started participating in the network or any of the potential issues that would prevent my insurance from covering the treatment.

So I'm left at the mercy of the word of the doctor and the customer service rep - and even then I can likely expect some billing foul-up that will require a bunch of my time to sort out.

As they say: freedom isn't free.

I'm not sure how freedom is part of this at all.

Neither am I but the opponents of health care reform have been beating the "freedom" drum in their opposition to a somewhat more sane health care system quite a bit. So I thought this was an excellent example of how that "freedom" they're supposedly protecting here really isn't free.