This is rich…Just asked BCBS to provide more info in pending coverage claims, they replied…

My question was clear, why do pending claims not list what procedures are being claimed, or reason for denial? Only who the claimant is and an approximate date. I'm sure the claim contains all details, but they choose not to disclose this information until after the EOB is generated. To me, the actual patient. Here is their response:

Pending claims are just that, we received the claims and they are subject for medical review. A claim may take up to 30 business days, Monday – Friday. Once completed, you will receive an Explanation of Benefits on how the care was assessed. Deductible, copayment, coinsurance, member liability. You have access to view an XLS spreadsheet via, My Account Portal. My Account> Claims & EOBs> View My Claims, XLS Download, Custom Download, here you can populate your filters as to your needs. We thank you for contacting us and sincerely hope that this has resolved your inquiry. Of course, we are readily available for any additional questions that you may have. Please do not hesitate to contact us at the phone number that is noted on the back of your membership identification card. We are dedicated to prioritizing our members needs and improving your overall healthcare experience. If you would like to give feedback on your experience today, please click Here to take a brief online survey.

Now the problem is my healthcare network does not provide this information either, until they send me a bill, and even then it's nebulous information, no details are provided. I have no idea what is being denied or why, and I have no idea what I'm paying for, unless I have details. I did receive a bill from a DME provider, and I called them to get details and disputed that I provided my own foot boot. If I hadn't have called them it would have cost me about $50, and the insurance company still paid out some $ on the claim before they billed me.

Can we go back to typed receipts from doctors offices and hospitals that just give line items for procedure and cost?

This is just so frustrating. TLDR: Insurance and hospital networks are not helping, and I don't know what I'm paying for. Bills should state line item charges and reason for denials.

submitted by /u/talltatanka
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