Blue Cross
Bernie Veldman
Description
Collection
Title:
Blue Cross
Creator:
Bernie Veldman
Date:
2/19/2002
Text:
Several months ago, I posted a request for input into everyone's experience
with BC/BS. I posted the responses, but needless to say they were
overwhelmingly negative.
The dilemma is:
The in-network fee schedule is far below even Medicaid pricing. (we would
even show a substantial loss by the time that we figure professional,
technician and administrative time into the equation) As an in-network
provider, we are forced to call and spend hours on hold not just once, but
many times in order to have them send the check to the patient who
invariable buys a television or stereo system with it, but then does not
have the financial resources to pay us for a service that we provided.
As an out-of-network provider, we are actually paid at a higher allowed
amount. We have the option of writing off a portion of the patient's
out-of-pocket expense, so that they are not penalized for going to one of
the evil out-of-network providers. BC/BS however, will then send the
check to the patient, usually within two weeks and it would be our
responsibility to collect from the patient/client. Even writing off a
portion of the patients out-of-pocket, we come out far ahead of in-network
coverage.
I have read many discussions through this group regarding the legalities of
billing issues. Many have said that it is illegal to bill for these
services until the orthosis is actually delivered. I would like to read
this law or directive or guideline or whatever. Where can I find more
information about this subject.
It should be a feasible scenario to bill out of network at the time of
casting / measuring. Then by the time that we are ready to schedule a
fitting, the patient should have received a check from BC/BS. They would be
required to turn over that check at the time of delivery. If, for some
reason there were to be a problem at the fitting, or the patient/client did
not return for a fitting, we could then make the appropriate adjustment with
BC/BS and let them collect the money from their client. This would mean
many, many hours saved on the telephone. It would also put some of the
responsibility back into the hands of the patient/client.
We have studied our contract with BC/BS extensively, and there is no mention
of the date-of-service being required on the date-of-delivery the way that
the Medicare manual states. If I am in error here, please let me know. I am
at my wits end with the entire Anthem BC/BS network, but I do not like to
turn away patients/clients that our referral base sends to me.
Thanks in advance for the input. I will post responses without names.
Bernie T. Veldman
BOC Orthotist
<Email Address Redacted>
www.surestep.net
with BC/BS. I posted the responses, but needless to say they were
overwhelmingly negative.
The dilemma is:
The in-network fee schedule is far below even Medicaid pricing. (we would
even show a substantial loss by the time that we figure professional,
technician and administrative time into the equation) As an in-network
provider, we are forced to call and spend hours on hold not just once, but
many times in order to have them send the check to the patient who
invariable buys a television or stereo system with it, but then does not
have the financial resources to pay us for a service that we provided.
As an out-of-network provider, we are actually paid at a higher allowed
amount. We have the option of writing off a portion of the patient's
out-of-pocket expense, so that they are not penalized for going to one of
the evil out-of-network providers. BC/BS however, will then send the
check to the patient, usually within two weeks and it would be our
responsibility to collect from the patient/client. Even writing off a
portion of the patients out-of-pocket, we come out far ahead of in-network
coverage.
I have read many discussions through this group regarding the legalities of
billing issues. Many have said that it is illegal to bill for these
services until the orthosis is actually delivered. I would like to read
this law or directive or guideline or whatever. Where can I find more
information about this subject.
It should be a feasible scenario to bill out of network at the time of
casting / measuring. Then by the time that we are ready to schedule a
fitting, the patient should have received a check from BC/BS. They would be
required to turn over that check at the time of delivery. If, for some
reason there were to be a problem at the fitting, or the patient/client did
not return for a fitting, we could then make the appropriate adjustment with
BC/BS and let them collect the money from their client. This would mean
many, many hours saved on the telephone. It would also put some of the
responsibility back into the hands of the patient/client.
We have studied our contract with BC/BS extensively, and there is no mention
of the date-of-service being required on the date-of-delivery the way that
the Medicare manual states. If I am in error here, please let me know. I am
at my wits end with the entire Anthem BC/BS network, but I do not like to
turn away patients/clients that our referral base sends to me.
Thanks in advance for the input. I will post responses without names.
Bernie T. Veldman
BOC Orthotist
<Email Address Redacted>
www.surestep.net
Citation
Bernie Veldman, “Blue Cross,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/218027.
