So frustrated!
more of a rant than anything.
We have blue cross blue shield (PA), and routinely find there to be disputes that arise – largely from miscoding at the provider. The most recent one was my finding i'm being billed $500 for a singles vaccine. Both BCBS AND the provider classify vaccines as preventative and BCBS specifically indicates that vaccines are NOT to be applied towards the deductable, but covered 100%.
After 4 months of back and forths with the provider and the insurance – with responses ranging from:
We miscoded it, we'll take care of it, to
It's coded correctly (it is coded as a diagnostic code – not a preventative code), so you'll need to pay for it, to the most recent version of:
Since you got the vaccine at the provider (my family doctor which is in network) and NOT at a pharmacy, the provider's coding of it as a diagnostic event and not as a preventative event is accurate, and that i somehow should have known that i was supposed to go to a pharmacy to have the vaccine given – at which point it would have been coded accurately as a preventative.
I've spent dozens of hours on this, and frankly have simpy given up and paid it. I don't have the time or energy to keep doing this – which is clearly the business strategy. The provider won't join a 3 way call with the insurance, and it's not legal for me to sue the insurance company.
There's GOT to be a way to address this. ANY other business would simply be sued for breach of contract. Damnit i'm tired of this system. And this coming from a C-suite person with 30 years experience and a professor for a spouse. I can't imagine how difficult it must be for, say, a plant worker who can't spend hours on the phone because they need to run a machine. sigh.
submitted by /u/Sebvad
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