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

[Pinocchio Liberal 268]

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).

** it! just fly to the UK. Its easier that way and you wont have to worry. Just call a couple years ahead, that way they can squeeze you in.

[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).

** it! just fly to the UK. Its easier that way and you wont have to worry. Just call a couple years ahead, that way they can squeeze you in.

What's your problem Marc?

I'm asking people here for advice - if you don't have any perhaps you should try butting out.

[Pinocchio Liberal 268]

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).

** it! just fly to the UK. Its easier that way and you wont have to worry. Just call a couple years ahead, that way they can squeeze you in.

What's your problem Marc?

I'm asking people here for advice - if you don't have any perhaps you should try butting out.

Have a blankey! I tried to help! your just to busy bein a fvckin victim! I'm out!

[Trumplestiltskin 5,791]

When a person has insurance coverage and can't get a straight, direct answer from the insurer as to which doctor is or isn't part of their provider network - that's clearly a fvcked up system.

When a person defends a fvcked up system like that, finding ways to defend something that is clearly to your own disadvantage - that makes YOU the victim Marc.

[w¡n9Nµ7 §£@¥€r 123]

Having to imagine a life without his chains frightens him.

[Trumplestiltskin 5,791]

[Pinocchio Liberal 268]

Call 1 800 cry baby! See who answers. Might get a fvckin echo!

[Trumplestiltskin 5,791]

Call 1 800 cry baby! See who answers. Might get a fvckin echo!

I think you could do with a dose of "what the ** are you on about", followed by two shots of "grow the ** up".

[Pinocchio Liberal 268]

Call 1 800 cry baby! See who answers. Might get a fvckin echo!

I think you could do with a dose of "what the ** are you on about", followed by two shots of "grow the ** up".

Here have the one you fvckin gave me! You know its true!

Here ya go girl! ohhhhhhh and ohhhhhhhhh!

Edited November 3, 2009 by ={Rogue}=

[Danno 1,228]

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

Yeah, it's a little telling that Ole Pike can't navigate this simple situation.

I have been with BCBS for over a decade and have searched for providers a number of times, my only problem was deciding on which one to pick, there were so many...they even had some listed in Russia. (though I have never needed their service).

I chuckle at imagining how much more simple the Gov. will make all this for us.

There are more Medicare approved providers than mighty BCBS, Danno.

But how many are taking new patients?

A few family members report this as a problem.

But I missed your point in the first place are you clapping because Big Gov has more providers than BCBS. ......one insurance co.?

[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.

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).

That sounds odd to me--normally the doctor's office takes care of this sort of thing. They know what they're doing (usually), what forms and documentation to file, etc. Was this preauthorization for an appointment, or for a procedure? I can't say that I've been told to take care of my own preauthorization. Maybe someone else can weigh in on this?

In any case, BSBS is a major carrier. You shouldn't have this much trouble. Perhaps the person you talked to at the doctor's office is new and/or doesn't know what's going on?

I wish you luck--I know this stuff is a nightmare. I don't know too many people who haven't had some degree of trouble dealing w/ this sort of thing. It's horseshit on a stick, truly.

[Pinocchio Liberal 268]

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).

That sounds odd to me--normally the doctor's office takes care of this sort of thing. They know what they're doing (usually), what forms and documentation to file, etc. Was this preauthorization for an appointment, or for a procedure? I can't say that I've been told to take care of my own preauthorization. Maybe someone else can weigh in on this?

In any case, BSBS is a major carrier. You shouldn't have this much trouble. Perhaps the person you talked to at the doctor's office is new and/or doesn't know what's going on?

I wish you luck--I know this stuff is a nightmare. I don't know too many people who haven't had some degree of trouble dealing w/ this sort of thing. It's horseshit on a stick, truly.

Six just be throwin a fit thats all. He just needs some hand holdin.

[maggieNomar 0]

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.

Rebecca is right. I also work with insurance claims/billing, and when I call to verify benefits, I always have to listen to their disclaimer recording that says benefits quoted are not a guarantee of payment. Which I agree is totally retarded. Why am I calling to check benefits if they aren't necessarily correct? I actually 'verified' benefits on a patient, was told she had 20 visits for the calendar year. She came for 10 before we got our first EOB back stating she didn't have acupuncture benefits!!! Unfortunately the patient is stuck with the bill because the contract is between them and the insurance, not between us and them and us and the insurance. And that creates bad will between the patient and doctor. I agree that it sucks though. For all concerned, except of course the insurance company.

[rebeccajo 14]

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

Yeah, it's a little telling that Ole Pike can't navigate this simple situation.

I have been with BCBS for over a decade and have searched for providers a number of times, my only problem was deciding on which one to pick, there were so many...they even had some listed in Russia. (though I have never needed their service).

I chuckle at imagining how much more simple the Gov. will make all this for us.

There are more Medicare approved providers than mighty BCBS, Danno.

But how many are taking new patients?

A few family members report this as a problem.

But I missed your point in the first place are you clapping because Big Gov has more providers than BCBS. ......one insurance co.?

Medicare providers aren't 'big government'. They are doctors and hospitals who have credentialed with Medicare and contracted with Medicare for payment. 'Big Government' doesn't pay the doctor his salary. 'Big government' doesn't own the hospital.

And I would hedge a guess that if your family members' doctor isn't taking new Medicare patients, he isn't taking any new patients. Period. No matter who is paying the bill. But that's only me applying common sense.

[Mr. Big Dog 10,747]

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

Yeah, it's a little telling that Ole Pike can't navigate this simple situation.

I have been with BCBS for over a decade and have searched for providers a number of times, my only problem was deciding on which one to pick, there were so many...they even had some listed in Russia. (though I have never needed their service).

I chuckle at imagining how much more simple the Gov. will make all this for us.

There are more Medicare approved providers than mighty BCBS, Danno.

But how many are taking new patients?

A few family members report this as a problem.

Of course, you know that the problem of finding a doctor that accepts new patients is not exactly isolated to Medicare beneficiaries. In fact, Medicare beneficiaries not only report higher overall satisfaction with their health plan (56% rate it 9 or 10 on a 0-10 scale) than those subject to private insurance companies (only 40% give their plans a 9 or 10 rating) but they give significantly higher scores for their ability to access to care (70% say they always get access to needed care). Among those with private insurance plans, only 51% are happy with their access to care.

Add to this the high trust that Medicare beneficiaries place into the program - 68% say that Medicare puts the patient first. 78% say that about their doctor and 74% say this about nurses but only 48% feel that way about their private health insurance company. Top it all off with the lower cost growth in Medicare vs. private insurance plans - the cost under the latter has grown almost 50% more than under the former over the last three decades - and I'd say that there's a pretty strong argument that the government does a better job in running health care coverage plans than the private enterprise.