Appealing a BCBS claim

60 days

288 Days

Never done one over the holidays...I would expect that to add a month to the process

What beef do you have with Bourbon County Brand Stout?

quote:

---

Just curious did the health care professional who provided the service being denied offer to help with the appeal?

---

No, they just want their money.
They were able to verify coding that BCBS said were "incorrect" and were, in fact, correct. Then when I cleared that up, they said they needed to "verify diagnosis" with my doctor and then when I got my doctor's office to provide that, they said they didn't need that. I am so confused.

It varies. You'll likely end up calling whatever blue you're on several times telling them the same shite over and over. I broke a finger and had a doctor put a cast on it. Well someone screwed up a keystroke and they billed me for 21 broken fingers. So I went back and forth between the Blue and the provider 4 or 5 times each. Finally I asked a lady "look how much does it cost to tape a Popsicle stick to one finger?" she got quiet for a few seconds and then realized the issue and fixed it.

Each time I'd talked to someone on either end they looked at it and "reprocessed the claim" because it was denied. Eventually someone realized an error and fixed it.

Communication is important. Just make sure the provider is noting your account that you're working on it when you talk to them.

BCBS can be difficult. I went round and round with them over a denial of coverage. They kept shifting the goalposts so I eventually mailed in the $300 that was disputed.

1st reason for denial: Vision not covered under my health plan. FALSE
2nd reason for denial: daughter over the age of twelve, so not covered. FALSE
3rd reason for denial: procedure unnecesaary...

Doctor wrote a memo indicating his opinion that it was necessary...this was a pre-procedure scan to allow him to do his due dilligence. When I discussed it with Dr. Balkan I decided to pay as I was glad he did it. dont want to take chances with daughter's vision regardless of BCBS penny-pinching.

I gave up and mailed it in (yes, I'm part of the problem).

On the other hand, BCBS paid a very large sum when my wife was hospitalized rpior to her delivery of our twins.......

Takes a while. You have to stay on it like it's your job. Don't give in though. I ended up having to get a lawyer to send a letter and that got their attention. I'm lucky I have plenty attorneys in my immediate family. It was well worth it, as it was a $50,000 claim. Meaning, they claimed that was my responsibility. Such bullshite. Ended up getting it down to $2500 and then and even bigger discount with the hospital when I offered to pay in full. Insurance is such bullshite.