Anyone with BlueShield of CA have problems with acupuncture coverage out of state?

I've been dealing with them for about a year now of not processing claims properly.

Their acupuncture coverage is supposed to be managed by American Specialty Health (ASH), but the ASH network only exists in CA. I don't live in CA. So of course all acupuncturists outside of CA are going to be out of network.

I've had to call at least twice for every claim to be processed properly, even as out of network and being applied to the OON deductible. I've been told by different people that CPT code 97810 (this is the code actually sticking needles in a person) is specifically excluded for out of network practitioners, but no one seems to think that that makes absolutely no sense. And I can't find anything in our plan documents that actually says this.

I've gone through the access to care process and now visits are supposed to be processed as in-network, but that's still not happening every time I submit a claim.

I've submitted a grievance, and that was denied – basically ignoring the problem I reported. And I've also recently submitted to the Department of Managed Healthcare for review of the issue. I'm not confident they'll do anything about it.

I just wanted to come here and see if anyone else had this problem (and if so, what you did).

submitted by /u/Ch33sypoufs
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