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

[Pinocchio Liberal 268]

Its easy to make light of other people's problems isn't it.

Give me your info. I will have it taken care of by noon tomorrow! Nuff said.

[Trumplestiltskin 5,791]

The point is you can't make sure - because the only information you have to work with is to take someone's word for it and trust that the relevant paperwork was filed correctly to ensure the requirements for coverage were met.

[Pinocchio Liberal 268]

The point is you can't make sure - because the only information you have to work with is to take someone's word for it and trust that the relevant paperwork was filed correctly to ensure the requirements for coverage were met.

Have the Dr. cost it out for you before the procedure! Sheesh. DUH!

[Trumplestiltskin 5,791]

How will that help?

[Pinocchio Liberal 268]

How will that help?

It will tell you what the outta pocket will be! which by doin a little math will tell you if they are in-network or out.

[Trumplestiltskin 5,791]

How will that help?

It will tell you what the outta pocket will be! which by doin a little math will tell you if they are in-network or out.

Marc - the option here is either to pay a $40 co-pay at 100% coverage (in-network) vs. paying a $40 co-pay plus X% of the submitted charges at a later date against a deductible (out of network).

[Pinocchio Liberal 268]

How will that help?

It will tell you what the outta pocket will be! which by doin a little math will tell you if they are in-network or out.

Marc - the option here is either to pay a $40 co-pay at 100% coverage (in-network) vs. paying a $40 co-pay plus X% of the submitted charges at a later date against a deductible (out of network).

Roll them dice! You did with the mechanic.

[Trumplestiltskin 5,791]

So in other words Marc, you don't know what you're talking about.

Interesting to see a guy like you so willingly accept the role of a victim.

[Empress of Groovy 373]

Have you had a preauthorization done before? Most doctor's offices will submit one to the insurer prior to a procedure being performed. If you know you need to have something specific done, this should answer a couple of your questions: whether the procedure is covered and at what percentage, and whether the provider is on the plan.

I'm not sure there's an easy answer to your more general question; we just have a seriously messed up system based on indecipherable and highly variable "rules." You'd think insurance companies would be able to answer basic questions about coverage and participating providers, but alas, it's artificially confusing, and often the patient is left holding the bag.

[Trumplestiltskin 5,791]

Have you had a preauthorization done before? Most doctor's offices will submit one to the insurer prior to a procedure being performed. If you know you need to have something specific done, this should answer a couple of your questions: whether the procedure is covered and at what percentage, and whether the provider is on the plan.

I'm not sure there's an easy answer to your more general question; we just have a seriously messed up system based on indecipherable and highly variable "rules." You'd think insurance companies would be able to answer basic questions about coverage and participating providers, but alas, it's artificially confusing, and often the patient is left holding the bag.

Well the doctor told me to ask the insurance company if pre-authorisation was needed. I called, asked them - they said no.

(but these are the same people who can't tell me whether the doctor is or is not in network).

[AlHayatZween 2]

The point is you can't make sure - because the only information you have to work with is to take someone's word for it and trust that the relevant paperwork was filed correctly to ensure the requirements for coverage were met.

Have the Dr. cost it out for you before the procedure! Sheesh. DUH!

Because the admin staff in doctors' offices are so forthcoming with prices before a procedure? Have you ever even tried to figure out how much a procedure would cost before actually getting it done...?

Either a) You don't know what you are talking about...

or B ) You don't know how lucky you are with the insurance coverage that you have.

Edited November 3, 2009 by AlHayatZween

[AlHayatZween 2]

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?

Apparently they can be... ?

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!!

All that being said, i'm just happy that the insurance is covering me for what i need done!! Small victories!

[Mr. Big Dog 10,747]

x

Edited November 3, 2009 by Mr. Big Dog

[Kathryn41 3,205]

Gene, you have my sympathies. I have had to call and ask first if the doctor takes my BCBS and then, if they are an in-network provider. I have been told yes to both, only to find out that while other doctors at the clinic were in network, the one they scheduled me with wasn't. I have also requested a cost breakdown prior to procedures and the doctors have supposedly called BCBS based upon my plan information and came back with a quote. The quote was a deciding factor on whether or not to get the test. I was told my copay for the test would be $150 due on taking the test and the rest would be covered by my insurance. I later received a bill for $800 additional - apparently the test was only covered by my insurance IF I had reached my deductible and since I hadn't that was the amount I had to pay. Finally, I have spent so many hours on the phone back and forth between doctor's offices and the insurance office correcting coding errors and mistakes, acting as a middle man to get things sorted out. If I had not bothered to take this on, in my first year here we would have paid $5000 more than we were supposed to. Each year since I have had to get errors corrected by one or the other parties involved and while none of the amounts have equaled the $5000 of the first year, the amounts - always in the Insurance Company's favour - have ranged between $500 and $1100 incorrectly charged.

Call the doctor's office and get their statement that you are covered. Have them contact your insurance company and ask them to verify that the procedure is coverred - even if you don't need pre-approval - and find out at what rate. Then, call the insurance company yourself and verify with a person that the doctor and procedure are covered. You may still end up with a surprise - or an error - but you will be in a better position to fight it.

Health care in the US - yeah. Enough said.

[JVKn'CVO 11]

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?

Whenever you have that problem, call the doctor's office first - they are usually the ones that did not file the claim right and that's the problem. It seems that I have to do this every time I go to the doctor.

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! )

Saludos,

Caro