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Thread Title: Blue Cross Bill Review
Created On Tuesday March 11, 2008 10:30 AM


denisenewkirk
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Posts: 191
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Tuesday March 11, 2008 10:30 AM

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BC has entered the bill review market. In the past year, SCIF, Berkshire Hathaway and other carriers have contracted with BC to provide bill review services. BC is singlehandedly burying the last of the stalwart wc providers. The number of errors they make in bill review is astronomical. These are not denials for lack of authorization or other "arguable" differences. Instead, they are a comedy of errors such as placing the "allowed amount" in the "PPO reduction" column of their EOR and paying nothing as a result. For providers who provide more than one procedure on a single date of service, BC seems incapable of reading past the first procedure listed in the report and will not pay on any of the others stating they are lacking documentation (when, of course, all procedures are reported, just not in the first paragraph). What is burying providers, in addition to having to wait for payment, is the time and expense required to deal with these erroneous denials. In order to counter BC's mishandling, a provider has to write a letter to the carrier explaining the issue, photocopy the bill and report and incur the expense of mailing it a second time. While this usually results in payment, carriers DO NOT pay increase and interest when the payment is beyond statute deadlines even though the delay was clearly their mistake. Of course, oftentimes BC compounds the error upon the second review and writes back and says they paid according to fee schedule when, in fact, they paid nothing. Negligence is definitely ocurring here, whether with criminal intent (fraud) or not, I do not know. I will be submitting another whole round of Audit Unit complaints, which is time consuming and costly too.

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Denise
Medical Biller

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TOBDNCNG@aol.com
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Tuesday March 11, 2008 4:15 PM

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Hope that they don't get away with this for too long. Hopefully, the audit unit will put a stop to it.

I know when I was at the County facility and still a County employee, I had BC and it took over a year to get them paid. I fell and hit my head pretty hard. They sent the bill many times and finally sent me to COLLECTIONS!!!!

Later that year, they terminated their relationship with BC due to these types of shenanigans. Now, I have to go to Loma Linda if I have an emergency and they are ALWAYS too busy!

Not that I have BC anymore, but it is sad that they have a PATTERN of doing this. You would think that having more places for their members to go would be a helpful thing!!! And being honest about their payment practices would be good for business! I guess not.

Hope you win with the Audit Unit. I am rooting for you!!!

Glowing,

Marygrace~

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Michaelb
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Saturday March 29, 2008 7:43 AM

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Denise, you are right.
It appears they use the same reviewers for WC as other types of insurance.
I have called numerous times and they are as dumb as a box of rocks regarding WC.
Escalate it to a supervisor immediately to get results.
Then after getting payment. Send a bill to the WC adjuster for the penalties as only they can authorize it.

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denisenewkirk
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Posts: 191
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Monday March 31, 2008 12:29 PM

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Michael, I love your description, "dumb as rocks" because it sure does fit. Yes, lots of calling and letter writing does get the service fee paid, eventually, which validates my point that this is breaking provider's backs financially. As you well know, phone calls to Blue Cross are never quick. One has to navigate the push this button for that and this button for this robot system for quite some time before one can obtain a live person and then the fun begins. I have placed my phone on speaker and waited over 1 1/2 hours while I did other work for an available live person at BC before. I was told by one adjuster recently when I called to request the P&I they had failed to pay that, "we do not pay anyting unless BC recommends it". BC doesn't even have the phrase "penalties and interest" in their vocabulary!

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Denise
Medical Biller

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