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

[mawilson 2,133]

In other news, Humana, the health insurer, posted a 65 percent rise in third-quarter profit. The company reported earnings of $301.6m, or $1.78 per share, up from $183m, or $1.09 per share a year before. Revenue rose 8 per cent for the quarter to $7.72bn.

[Hilarious Clinton 452]

I created an account with BC/BS and just click "find a doctor". Works for me.

[SMR 368]

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.

I have found that their website has very messed up interactions with the back button. Basically, you have to use the "back to search" or "back to results" options. For being an insurance giant, you would think they could make a website that would actually work.

I firmly agree that the health care industry is messed up. I just find it very far-fetched to expect that the government would do a better job. What's the precedent for believing that?

[Trumplestiltskin 5,791]

The provider list isn't up to date either.

[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.

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.

It the illusion of choice - that if you don't like your insurance or coverage that somehow you can take it on yourself to get something better. That might work for someone like Donald Trump, but for everyone else - good luck. Practically, it isn't true and never has been - all it is is part of the stale conservative free market rhetoric, a robotic argument to trot out whenever there's a hint of someone mentioning "government control". Meaningless in any real sense.

[Mr. Big Dog 10,747]

In other news, Humana, the health insurer, posted a 65 percent rise in third-quarter profit. The company reported earnings of $301.6m, or $1.78 per share, up from $183m, or $1.09 per share a year before. Revenue rose 8 per cent for the quarter to $7.72bn.

Great, 65% rise in profits on 8% rise in revenues? That's a healthy mix. For the investors, that is. Not so much for the individuals insured by this company...

[rebeccajo 14]

The provider list on most insurance websites can be out of date for any number of reasons.

The doctor could be dead. Or moved.

They could have failed to update their credentials with the insurance company - something that (usually) must be done annually.

You really are better off actually calling the provider (doctor) and asking if they are in-network.

I created an account with BC/BS and just click "find a doctor". Works for me.

Well, you're a trusting soul, aren't you?

[kaydee457 13]

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

Careful what you wish for......

[Trumplestiltskin 5,791]

The provider list on most insurance websites can be out of date for any number of reasons.

The doctor could be dead. Or moved.

They could have failed to update their credentials with the insurance company - something that (usually) must be done annually.

You really are better off actually calling the provider (doctor) and asking if they are in-network.

I get that - its just amazing to me that the insurer doesn't have information that it seems (to me, anyway) that they really should have.

[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.

Careful what you wish for......

Why?

[Trumplestiltskin 5,791]

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

Careful what you wish for......

Why?

That wasn't a warning it was a joke and you've cut out the punchline

"Do you miss me yet?"

[rebeccajo 14]

The provider list on most insurance websites can be out of date for any number of reasons.

The doctor could be dead. Or moved.

They could have failed to update their credentials with the insurance company - something that (usually) must be done annually.

You really are better off actually calling the provider (doctor) and asking if they are in-network.

I get that - its just amazing to me that the insurer doesn't have information that it seems (to me, anyway) that they really should have.

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.

[Trumplestiltskin 5,791]

Well that's effed up.

[mawilson 2,133]

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?

[rebeccajo 14]

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.

Edited November 2, 2009 by rebeccajo