Order of claims received resulting in huge amount owed (Premera)

Hey folks,

Hoping to get some assistance with a tricky situation that has happened with Blue Cross Premera.

On 1/17 of this year, I had a procedure which resulted in three claims (one for the procedure, one for the anesthesiologist, and one for hospital fees – with the latter two being in network) all under the same date of service 1/17. The first claim was a huge out-of-network procedure that resulted in me paying almost $28,000 out of pocket. I'm ok with this.

The issue with this, however, is that due to administrative error in entering my correct DOB (either on the doctor's office end or on Premera's end), the claim for that big out-of-network cost was received a couple of months after the other two claims.

The order in which the three claims were received by Premera has now made it such that I owe almost $3,000 out-of-pocket for the hospital/anesthesiologist fees. If the claim for the actual procedure had been received by Premera first (and it should have been based on the date it was mailed), the amount I paid out-of-pocket (around $28,000) would have been applied to my deductible and coinsurance max and I would not owe anything for the hospital/anesthesiologist fees since they would be covered 100% by Premera.

I spent two hours on the phone with Premera today and it doesn't seem like there is any resolution in sight. Shouldn't the date the claims were received be totally irrelevant if the date of service was all the same? What if there was a hurricane, electrical outage, or worse, an administrative error that affected the date the claims were received and processed?

Any advice here? 🙁

submitted by /u/Overall_Vermicelli_7
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