Texas. Blue Cross Blue Shield (BCBS) PPO plan. Two week ICU stay at an 'In Network' hospital. We received numerous bills from different providers, some in network some out of network.
For out of network bills I contacted BCBS because the hospital is in network. BCBS agreed to re-classify the out of network statements to their in network terms since we had no choice of providers at the in network hospital.
I then contacted each of the providers. All but one agreed to the BCBS covered amounts and rebilled us as if they were in network. So far so good.
One hold out provider claims we have to pay their full prices, so the difference between the BCBS covered amount and their full price is in dispute. They tell me they canceled their contract with BCBS 12 days before services were provided.
What are my options? This appears to be a regular occurrence with PPO plans: the hospital is 'in network', yet many (most, it appears based on my bills) of the service providers at the hospital are 'out of network'.
1) Can BCBS claim the hospital is 'in network' when the majority of services provided there are 'out of network', and the patient has no choice once in the hospital who provides the services? This seems like false advertising and misleading information to me. BCBS appears to agree with this - they approved ALL services under their in network terms after I called them. I have documentation to show this.
2) Can I go back to BCBS and get them to pay the above provider's outstanding bills, with the argument that BCBS approved it as 'in network' and therefore they must take care of this provider's disputed amount as well? They've already told me the difference is my responsibility, which I have not responded to yet.
3) Can I claim that the provider falls under the hospital's status with BCBS as 'in network' since the service provider has a contract with the hospital, and the hospital has a contract with BCBS? Are there any other options for me with the provider?
4) This seems to be a widespread issue with PPO plans and 'in network' hospitals. Any links, references, etc., that explore this issue with the insurance industry?
For out of network bills I contacted BCBS because the hospital is in network. BCBS agreed to re-classify the out of network statements to their in network terms since we had no choice of providers at the in network hospital.
I then contacted each of the providers. All but one agreed to the BCBS covered amounts and rebilled us as if they were in network. So far so good.
One hold out provider claims we have to pay their full prices, so the difference between the BCBS covered amount and their full price is in dispute. They tell me they canceled their contract with BCBS 12 days before services were provided.
What are my options? This appears to be a regular occurrence with PPO plans: the hospital is 'in network', yet many (most, it appears based on my bills) of the service providers at the hospital are 'out of network'.
1) Can BCBS claim the hospital is 'in network' when the majority of services provided there are 'out of network', and the patient has no choice once in the hospital who provides the services? This seems like false advertising and misleading information to me. BCBS appears to agree with this - they approved ALL services under their in network terms after I called them. I have documentation to show this.
2) Can I go back to BCBS and get them to pay the above provider's outstanding bills, with the argument that BCBS approved it as 'in network' and therefore they must take care of this provider's disputed amount as well? They've already told me the difference is my responsibility, which I have not responded to yet.
3) Can I claim that the provider falls under the hospital's status with BCBS as 'in network' since the service provider has a contract with the hospital, and the hospital has a contract with BCBS? Are there any other options for me with the provider?
4) This seems to be a widespread issue with PPO plans and 'in network' hospitals. Any links, references, etc., that explore this issue with the insurance industry?
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