Blue Cross out of state
Kevin Matthews
Description
Collection
Title:
Blue Cross out of state
Creator:
Kevin Matthews
Date:
6/27/2013
Text:
Hello all,
Over the years I've been very frustrated with Blue Cr
Hello all,
Over the years I've been very frustrated with Blue Cross when it's an out of state based group. Are you having these issues to?
We routinely get denials from these plans, thankfully there are few that have these plans. Walmart is one. We have to fight them almost every time. Currently I am frustrated by a New Jersey plan. They denied SMOs for a child. They said they are considered foot orthoses and FOs not covered. We appealed saying the first word in the Medicare description is AFO,...Insurance is regulated by the state. Since they are out of state all our appeals and phone conversations need to be passed through a Texas plan rep. They have absolutely no authority, they simply pass on the message. We cannot speak or communicate directly with the plan administrators. This is chronic by the number of times it's happened and the few claims there have been like this.
My thinking is that businesses have no standing in other states so it is hard to prosecute complaints. We almost always get paid, but they put us through the course.
Is this just us? I'll post replies if any. Are SMOs considered FOs in New Jersey?
Kevin C. Matthews, CO/LO
Advanced Orthopedic Designs
12315 Judson Rd. #206
San Antonio, Texas 78233
210-657-8100
210-657-8105 fax
www.AdvancedOrthopedicDesigns.com
<Email Address Redacted>
Over the years I've been very frustrated with Blue Cr
Hello all,
Over the years I've been very frustrated with Blue Cross when it's an out of state based group. Are you having these issues to?
We routinely get denials from these plans, thankfully there are few that have these plans. Walmart is one. We have to fight them almost every time. Currently I am frustrated by a New Jersey plan. They denied SMOs for a child. They said they are considered foot orthoses and FOs not covered. We appealed saying the first word in the Medicare description is AFO,...Insurance is regulated by the state. Since they are out of state all our appeals and phone conversations need to be passed through a Texas plan rep. They have absolutely no authority, they simply pass on the message. We cannot speak or communicate directly with the plan administrators. This is chronic by the number of times it's happened and the few claims there have been like this.
My thinking is that businesses have no standing in other states so it is hard to prosecute complaints. We almost always get paid, but they put us through the course.
Is this just us? I'll post replies if any. Are SMOs considered FOs in New Jersey?
Kevin C. Matthews, CO/LO
Advanced Orthopedic Designs
12315 Judson Rd. #206
San Antonio, Texas 78233
210-657-8100
210-657-8105 fax
www.AdvancedOrthopedicDesigns.com
<Email Address Redacted>
Citation
Kevin Matthews, “Blue Cross out of state,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/235236.
