Insurance and providers not communicating
I have a BCBS PPO plan through my employer. Starting in 2023, employer switched to self-funding the insurance and using HealthComp as a third party administrator to handle all claims. This all worked fine until April of this year, when suddenly every health provider had problems getting claims submitted/paid, and HealthComp would have no record of any billing attempts. The providers blame insurance and insurance blames the providers, and I'm the one stuck with surprise bills for hundreds of dollars that I shouldn't owe for in-network care.
My toddler sees several specialists at a major hospital/medical group near us. They are in-network and we never had any trouble with their billing until this April. My child had a routine office visit that month. In May I received a bill for $500 (the list price for an office visit, minus copay we had paid). I call the provider's billing office and speak to a condescending dickhead who insists I must have had a lapse in coverage, they definitely submitted the claim correctly, no they can't resubmit the claim, and his time is too important to wait for me to patch in HealthComp on the call. I call HealthComp, and of course they had no record of any claim submitted. The HealthComp rep calls the hospital billing office on my behalf and says she got it sorted out with them. The bill is withdrawn pending insurance.
In June, the provider sends me another bill for the full amount of that April visit (oddly, it's now $600 instead of $500). I have HealthComp call the billing office again. The bill is withdrawn pending insurance.
I subsequently noticed two claims for that visit were processed by Health Comp, EOBs showing $0 as the plan rate, $0 paid by the plan, and $0 owed by me. Weird, but it's between the provider and insurance company now, at least. Right?
Wrong. Now it's July and the provider is once again here to bill me for that $500…
Some version of this back-and-forth has happened with multiple providers for my family. It's driving me crazy and is a serious impediment to seeking medical care. It seems to me the problem is between the provider(s) and my insurance, and I am therefore not in a position to fix it . Am I doomed to spend an hour on the phone every time someone in my family visits a doctor? Any suggestions?
submitted by /u/lirulin17
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