Blue Cross Blue Shield of TN and out of network procedure help

My primary doctor suggested a routine colonoscopy, and I asked him to send me to a specialist who is in my BCBS network.

When the specialist's office called me to make the appointment, I gave them my insurance info and asked them if they were indeed in my network. They said yes.

I had the procedure done and went on my way.

This week (over a month later) I get a claims email from BCBS. They paid for the anesthesia, but not the doctor, lab test, or hospital. "Provider is out of network." The total is nearly $6k. Why would they pay for part of it, and not the rest, if it's all in the same office?

I called BCBS and they told me that any time I'm referred to a doctor or specialist, that I should call BCBS first and make sure they're in the network. That'd suck if I were in a life-threatening situation.

I trusted both my doctor and specialist to let me know that the insurance plan was accepted; otherwise, I wouldn't have gone. A now-costly mistake.

Any ideas on how to proceed? Any health insurance insiders who can offer some advice? The BCBS agent sent me a grievance letter to fill out and suggested I contact the specialist and hospital to put a hold on my bill while this is being sorted out.

I found some medical hack online and wanted some opinions on trying it out:

Call the insurance co. and ask to speak to their "HIPPA Compliance/Privacy officer" (by law they have to have one).

Ask for the names and credentials of everyone accessing the record to make the denial decision (by law we have the right to this info).

Supposedly the insurance co. will almost always reverse their decision, rather than admit that these folks are low-paid high school grads looking at criteria words to deny care/coverage.

submitted by /u/Zaxxter
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