Hi there. I am insured with blue
cross/blue shield network blue. I used my
insurance for the first time in jan. And
I am very confused by the fees I had to
pay two different physicians. The first
physician charged me $197 and the second
charged me $300, both were printed on the
invoices as office deductibles. The
second provider told me that bcbs would
refund me when I questioned this charge.
I e mailed bcbs, and was told that I was
only responsible for $30 copay for the
first and $15 copay for the second. They
stated that they called the second
provider and explained that I should not
have paid $300 and that once the provider
received the check from bcbs they would
arrange a refund. Since they did not
contact the first provider for me, I sent
them a certified letter with copies of all
correspondance with bcbs and a request for
a refund, three weeks have gone by and I
have recieved nothing. I also provided
copies of all correspondance from bcbs to
my second provider in person, a month has
gone by and still no refund. The second
provider also charged me $30 on two other
occasions when it should have been $15.
The last visit I had with them I was
charged $15 only because of the paperwork
I provided to them from bcbs. I am unable
to call bcbs or my providers during
business hours due to my job. I e mailed
bcbs over a week ago to see if they could
call these providers and explain their
obligation to refund me, however, I have
not heard back from them. Usually they
responded to me after a couple days so I
am thinking that maybe they will not get
back to me. Now I am starting to think
that maybe I was responsible to pay the
$197 and $300. Is there such thing as an
office deductible that a patient is
responsible for even though they have
insurance? I was going to send both
providers certified letters but I want to
make sure I have my information correct
before doing so. If anyone could assist
me I would greatly appreciate it. Thank
you so much!
|
Patient Advocate
New User, Becoming EHEALTHy
Joined: 20 May 2006 Posts: 5 Location: Florida
Answer to You Deductible Dilemma Posted: 05-20-06 18:49pm
Bcbs ins cards can be confusing to a
providers office staff. Sometimes the
card will say there is a deductible and/or
a copay. So they are unsure what to
collect.
Generally speaking if the provider was in
network, meaning they participate and have
a contract with bcbs, they should only
collect the copay. It is probably $15.00
for a family practice or internist and $30
for a specialist.
If they collected the $197 and $300 up
front and called this your deductible and
they are in network, then you should be
due a refund by the provider. Bcbs is not
the one who collected it from you and will
not be the one refunding it to you.
If they are not in network, then you may
not have a credit. However, if they filed
a claim they should have checked a box on
the claim form that tells bcbs to mail
reimbursemnt to you (if any).
The correspondence bcbs sends you will
show the contracted rate and adjustment
and your responsibility to the provider.
If you paid more than what bcbs says you
are responsible for, they need to issue a
refund to you or they are in breach of
contract.
This is what I do for a living. I go to
bat for the patient.
|
Patient Advocate
New User, Becoming EHEALTHy
Joined: 20 May 2006 Posts: 5 Location: Florida
Answer to You Deductible Dilemma Posted: 05-20-06 18:51pm
Bcbs ins cards can be confusing to a
providers office staff. Sometimes the
card will say there is a deductible and/or
a copay. So they are unsure what to
collect.
Generally speaking if the provider was in
network, meaning they participate and have
a contract with bcbs, they should only
collect the copay. It is probably $15.00
for a family practice or internist and $30
for a specialist.
If they collected the $197 and $300 up
front and called this your deductible and
they are in network, then you should be
due a refund by the provider. Bcbs is not
the one who collected it from you and will
not be the one refunding it to you.
If they are not in network, then you may
not have a credit. However, if they filed
a claim they should have checked a box on
the claim form that tells bcbs to mail
reimbursemnt to you (if any).
The correspondence bcbs sends you will
show the contracted rate and adjustment
and your responsibility to the provider.
If you paid more than what bcbs says you
are responsible for, they need to issue a
refund to you or they are in breach of
contract.
This is what I do for a living. I go to
bat for the patient.
