Blue Cross/Shield

[kathysjourney]

Can anyone tell me if they know docs who take Blue Cross/Shield for surgery or GK, CK? Many hospitals are in-network, but I'm finding many doctors are not. I have called some, but it's a huge task to call every doctor I've heard of. Blue Cross doesn't have the doctor specialities broken down specifically to AN treatment, so it's like finding a needle in a haystack. This is a major issue, considering the treatment fees.  Yes, we are all worth it, but I would like to work within my system with the best possible doctors, whatever I choose to do.

[ppearl214]

Hi

I can only share from my own personal CK experience.

I had BC/BS of MA at the time of my CK treatment.  Since the CK center is based in an acute care facility, BC/BS paid 100% of R&C for in-network (the acute care facility, who does the actual billing was noted in-network).  For my pre- and post-CK dr appts, it all tied in with the CK treatment as pre-test/pre-'Op" and post-treat follow up care, again, in network since I meet with my CK team.

The billing dept at the radiation center will do the homework/research for you.  Advise them of your BC/BS info...... and share with them that you are looking to have the particular radiation with them. They will know to inquire about "sterotactic radio treatment" when they speak to BC/BS and will be able to confirm what will be covered and any potential out of pocket expenses.

for me, I only had to pay the dr visit (OV) co-payment.... and for me, the rest was covered. As we know, individual states/insurance plans will be different so ask the radio-center to phone BC/BS on your behalf and help you save time/energy/headaches.

Good luck!
Phyl

[krbonner]

There's such a huge variation in how insurance plans are administered by company, state, etc. that you really do need to work it through with the insurance dept at the medical offices.  They're probably the best qualified to get through all the muck of paperwork.

That said, I was covered by BCBS of MA at the time of my surgery.  I paid for office visit copays and had a hospital copay, but everything else was covered for my doctoros in Boston.

Katie

[Lizard]

Insurance can be a nightmare, just make sure you work through it before treatment so you don't have any surprises.
Good luck!
Liz

[LOIS]

Hi Kathy,

I had BCBS when I had surgery a year and a half ago.  My dr. was in network and so was the hospital but a lot of the drs on his team weren't.  As I got each bill from the out of networks, BCBS told me to write an appeal letter stating that my surgeon and hospital were in network and that I didnt have any control over everybody else involved.  I did and they then paid them the higher amount.  Some of them told me they would just accept what they paid, not to bother myself with the appeal and others bargained, sort of, asking if I would pay half or whatever I felt comfortable with and we would call it even.  It did all work out.  Hope this helps.  Wishing you the best and a speedy recovery.

God Bless,
Lois

[sunfish]

You really have to watch this with BC/BS when you have a procedure done at a hospital with several doctors on a team.  I got stuck with a $2K bill when my daughter had a heart procedure.  This go 'round, for my AN, I specifically asked this question and I've vowed to carefully review my related medical bills and follow up closely so this doesn't happen again.

[Dog Lover]

Don't know what state you're in, but I have BC/BS of IA and everything was in network for me at University of Iowa Hospitals & Clinics / Dr. Gantz.
For what it's worth....

Cathy

[Jim Scott]

Kathy ~

Insurance regulations vary from state to state, as you know.  I had Blue Cross /Blue Shield at the time of my surgery and FSR (radiation) and my doctors, hospital and radiation were all in-network and covered.  When making a doctor appointment, I would definitely ask whether they accept Blue Cross/Shield to save time and possible unpleasant surprises, later.

Jim

[Soundy]

at time of surgery I had CIGNA but was changed to BC BS of TN a year later ... aside from state you need to check the little letter that designates your network... I am in the S network ...high deductible and high out of pocket ... it cost less per month but doesn't pay well...they are also treating me as the AN being pre-existing and won't cover MRIs for rechecks even though we were told the change from CIGNA would be seamless and anything we were being treated for would be covered ...we were not given a choice in network... this was assigned ... if we could find insurance that we could afford not through place of work we would switch

talk to your agent or if through place of work the insurance liaison ...or go to BC BS website for your state ... on the Tennessee site I can look up what each network covers and also get a list of doctors and facilities  that accept the network plan ...also can create a profile and get details that are only related to my family ...

my son has BCBS of Alabama ... he had a baby , surgery on his shoulder and then his wife go back in hospital when her C section incision opened up all in the same week  ... his total cost for all of it was $1500 ..

you will just have to check details for state you are in and what network you are in...

[kathysjourney]

Thank you for your suggestions! I am so sorry you have been a victim of the red-tape of the health insurance system. This denial for "pre-existing" stuff  for aftercare is very scary, and I wish you the best. I thought that when you switched insurance through an employer, without a gap in coverage, that shouldn't happen. I certainly hope you will win this fight!

I am still pre-treatment, but not for long. I have been tenacious in calling BC and asking questions for more than a year. Since the answers vary a bit with each person I speak to (not to mention a change in our coverage for 2010!), I've kept a log of my calls, and keep calling. Finally I seem to have ironed out some things. There is a lot they won't tell you unless you specifically ASK about it using their "healthcare" terminology (which, of course, you don't KNOW when you begin), but I have learned alot through all the calls. The in-and-out-of-network stuff gets very complicated. You're very right that the health care coordinator at one's place of employment is a good initial advocate for guidance on how to proceed.

For newbies, talk to some doctors billing offices. They can't get very specific about your case unless you have scheduled treatment, but you will learn some things that may guide you to ask even better questions of your insurance company. Learn as much a you can ahead of time. In the beginning, I can't tell you how many people said "Oh - you can't think of money when it comes to your health". That is SO incorrect! You can call a doctor's billing office, and get the codes and charges for the procedures. Then you can call your insurance company to find out about your coverage. (the doctors won't discuss it; don't have the time OR the info). I am warning all my friends to study their policies while they have no health issues going on, and make any improvements/changes to their coverage before they have some big health issue come up! Then, be careful about the regulations/time frames on coverage for those changes. So many people don't understand the impact of coverage for specialists, or in-vs-out-network coverage, co-insurance, co-pays, deductibles, etc.

Thanks again, and I hope you are successful in rectifying that gap in coverage!

[Captain Deb]

Dito to what Sunfish said--go over your med bills with 2 fine tooth combs.  My hubby just paid them as they came in without reading them and when I could see straight after about two months later I found $5000 worth of  "denials" for a bunch of stuff that BCBS had tried to slip by me including billing my surgery and hospital stay as out-of-network, when I triple checked that it was in-network before I even scheduled my surgery.  It took about a year and countless phone calls to recoup my $5000, but I was a really squeeky wheel!

Capt Deb