BCBS billing code conflict

I have a PPO plan with Blue Shield of California (BCA) but I live in Maryland. Maryland's BCBS company is called CareFirst.

I have verified with BCA that the Maryland practitioner I want to see is in-network. That individual is employed by a practice that has a contract with CareFirst (the BCBS company for Maryland).

Does having an agreement mean the practice is in-network? Or can a practice have an agreement with a BCBS company but still be out-of-network?

The practice name is not listed as in-network. It appears only the individual practitioner appears to be in-network.

Is it typical that individual practitioners are in-network while the practice they work for is not listed as in-network? (This is confusing.)

There are two services supposedly covered by my plan that I would like the practitioner to provide: service A and service B. The practice told me that for patients with BCBS plans outside of CareFirst, claims are approved for service A but rejected for service B.

The practice explained to me that their agreement with CareFirst says they must use a particular billing code for service B that other BCBS companies do not accept. I confirmed with BCA that they don't accept the code the practice uses for service B; BCA gave me a code the practice should use instead. The practice says they can't use that billing code because it's not in their agreement with CareFirst.

The practice said they can't get CareFirst's provider relations department to do anything about this. As a result, patients with non-CareFirst BCBS plans pay the full cost for service B. The practice said this issue affects about two new patients a week.

Those of you who have experience with the BCBS system, have you seen this issue before? Where do I even begin to try and fix it? Much gratitude to you for any suggestions! submitted by /u/RoxyTyn
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