I did my due diligence and found a provider listed on the BCBS website listed as in-network. I verified with insurance and the whole nine yards. However, when BCBS adjudicated the claim, it was processed as OON to my surprise. When I questioned why, I was told the provider used a different NPI that is OON. In all seriousness, how is a patient supposed to know what NPI a provider bills under? Do I have grounds to appeal the OON determination or should I ditch this provider and find someone else?

I'm starting a new job in a month. It's remote, and I live in southern Arlington, VA. The health insurance the company provides is Blue Cross Blue Shield of Michigan, because it's a Michigan based hospital. My to-be manager (someone I know from a previous job) lives in Arizona and he said the pickings of doctors have been lacking due to it being BCBS of Michigan and he's in Arizona. I'm wondering if anyone has had similar experiences? Should I take the BCBS of Michigan health insurance (which doesn't cover anything birth control related so I'd have to get something to supplement that) and hope for good choices of doctors in Arlington, VA? Or go onto my husband's insurance with Kaiser Permanante even though it's more expensive?

My ADHD prescription has all of sudden stopped being covered by BCBS TN. What’s the fastest way to contact them to resolve this? I have emailed, chat function not available, and I have now been on hold for 3 hours. Has this happened to anyone else? I’m currently at Walgreens don’t know if that matters. But again, it has been covered in the past. It’s not feasible to pay $100+ for a prescription every month nor do I want to.

In two months, my husband and I are moving states and I will be 22 weeks pregnant. I am a teacher thus I will not start until August. Lapsing and insurance is stressing me out and giving me a lot of anxiety that I don’t need for the first trimester Please share any and all advice/ a step by step on what we should do in terms of health insurance, finding an OB, etc. currently on BCBS Florida blue through the school system, I work in.

I was on my domestic partners health insurance for a couple of months before they left their job. We had all the papers signed legally in front of a notary and I was officially listed on their insurance. However, they left their job and I am trying to get insurance again through Anthem Blue Cross Blue Shield by proving that I was on my partners insurance. Sadly it has been nothing but a back-and-forth struggle, sending paperwork, and asking for their phone number only to be ignored. I have given then my full name, my partners full name, my partners termination information, and I have even used the insurance at a local urgent care recently (plus printed out the document showcasing my full name listed as a domestic partner on their insurance). After proving I am who I am, they keep asking for more information and this time asked for my terimination date from my job to prove I was on the insurance. But I didn't leave my job. My partner did, which I have explained. They also asked for the loss of coverage date, but I have sent previous emails with that said date. Long story short: I am trying to prove I was a domestic partner on my partners insurance, only to be asked again and again for more paperwork (of ones specifically I have already provided). Has anyone else faced this issue? Is there any way I can go about this in a more efficient way or anyone I can contact? Thank you! I really appreciate the help.

A few weeks ago, I received the invoice for a medical visit that took place in November 2024. The invoice mentions two items: the visit to the doctor and a "facility charge." The first one is fully covered by BCBS except for a $40 copay, while the other is only partially covered, requiring a payment of $210, after the deductible. The code for the second item is **99204, "HC Office Visit New, Level 4.**" According to various accredited bodies including the **American Medical Association:** 'Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.' None of this applies to the actual visit: the entire visit lasted under 10 minutes, and no special machinery or tools were used. The diagnosis was visually evaluated. In other words, it seems that the level of service was intentionally overstated. I only have proofs that the visit lasted within 10 minutes, but no proof of what happened inside because obviously recording is not allowed. I first tried contacting the billing office by email, but they only told me to speak with a representative. I called and asked for an explanation, but they just forwarded everything to the Team Lead, from whom I still haven't received any updates. Meanwhile, this morning, I received a message from Nationwide, a collector agency, as an attempt to collect the debt. What do you suggest I do? * Pay the charge to the collection agency and move on? If so, won't it affect my credit score? If I understand correctly, under $500 it shouldn't. Fortunately, I don't have money problems, it's the principle that bothers me. The health system is essentially a mafia, they can do whatever they want to and nobody cares. * File a complaint with the Office of the Illinois Attorney General? I live in IL. * Something else?"

Hi all, thanks in advance for reading this. My situation is this: I’ve started a new job that had 3 options for health insurance. All were blue cross blue shield. 1 option was no hsa but in and out of network coverage. 2 options had hsa’s but one had in and out of network coverage and the other didn’t. I figured I’d get the was with a hsa and no out of network coverage. BCBS is very common where I live and figured no issues. Well, my son had to have surgery but before hand, we gave our new insurance to all the doctors and they said they accepted it with no problems. After the surgery, we received a $16,000 bill with a statement saying all procedures are not covered because we didn’t use in network doctors. So I make some calls and come to find out the nearest doctor or hospital that is in network is 2 hours away! Nothing around me is in network!? BCBS told me I should have chosen the insurance plan with hsa and out of network coverage. I have a 18 month old and a wife. I can’t wait till open enrollment to change health plans… what do I do?

Hello, I have a few questions how to handle my PCP or Labcorp messing up with my insurance details. I had a bloodwork taken at my primary care and apparently they sent it to Labcorp. But Labcorp billed my insurance with the incorrect details apparently - my name and Member ID, group number are wrong. I got a mail in Feb asking for insurance details but the return address was not online on their website, so I thought it was phishing. I called the Billing department and asked them if they needed my insurance details, and they said "it is pending with insurance and there is nothing you have to do but wait". I don't have this call recorded. Today I got the invoice number and it says the below: "Reason for Bill: We attempted to file a claim with insurance. According to BLUES NJ: HORIZON BCBS, the patient name or subscriber number did not match their records. This balance is now the patient responsibility" I don't want this to impact my credit score but I don't want to pay $1000 since my PCP or they made mistake that I had nothing to do with. I will call them tomorrow morning but I have a few questions. 1. Since they dumped the responsibility on me, can I sort of force them to refile with insurance? What do I do if they refuse? 2. How long generally do I have to sort this out (not paying) so it doesn't impact me. Thank you for taking the time to read this. I'm just pretty pissed right now so apologies if I sound rude.

I'm 41 and live in New Jersey. I work for a non-profit and make around $35k per year. A few months ago, I saw my GP for a regular check-up and mentioned that, in my job, people often speak confidentially, whisper, or are just low talkers, and I sometimes have trouble understanding them when it seems like there is an expectation that I should not, which can get frustrating. I said that I have not had my hearing tested since I was in grade school like 25 years ago and asked whether that's something that should be checked from time to time. She said sure and wrote me a referral to get a hearing test. So I went to the website for my insurance (Horizon, aka Blue Cross Blue Shield) to search for providers and easily found an audiology office that's tier-1 in my network a few blocks away. I called them, explained that I hadn't had my hearing checked in decades and was looking for a regular test with my doctor's referral, and gave them my insurance information so they could verify that they're in my network. I went for the test, which didn't really tell me much, and later I received the finalized claim notification and was surprised to see that I owe $1,041.85. I argued with the billing department, and then I argued with the insurance company. There are two different issues here, I've been told. First, insurance explained that the medical coding was for a diagnostic hearing test rather than a routine (annual) hearing test. (Obviously, no one ever gave me an option for which type of test I wanted to receive.) An insurance representative talked to the billing department while I was on the phone and was unable to convince them to change their coding; they insisted that they had coded it correctly and that it would be illegal to change it. Insurance doesn't consider it preventive care if it's a diagnostic test, even though their Preventive Health Guidelines document mentions "Doctor will ask about hearing difficulties and refer for further diagnosis" under "Other Recommended Screenings/Tests." When I escalated and spoke with a different insurance representative, she figured out the other issue, which became the main focus: I was billed as a hospital outpatient, not as a visitor to a specialist office. She was not able to change that by working with the billing department and filed an appeal internally with the insurance company on my behalf. About a month later, just the other day, I received a denial of the appeal in the mail. I can still file my own appeal, but I'm not sure how to get a different result. In the meantime, my "payment is overdue," and I'm worried about it going to collections and affecting my credit. The billing department isn't doing anything to hold the timeline even though I've told them repeatedly that I'm arguing with insurance about the bill and had them note it on my file. If I gave the audiology office my insurance up-front, didn't they have an obligation to inform me that the service wouldn't be covered? If I found the provider through my insurance website as in-network, didn't they have an obligation to inform me that the office was considered hospital outpatient and not a specialist practitioner? I should note that I live right by a hospital in a major healthcare city, and many of the facilities throughout the city are under their umbrella. My GP's office is also part of the hospital system. Their name is on the door. I use the same patient portal for my doctor visits as I got this bill through. So why, when my GP is a regular office visit, would this audiology office bill me as a hospital outpatient? I've had health insurance for almost 17 years through my job but only recently started exercising it at all. It's absolutely insane to me that I can be billed an amount like this without anyone letting me know up front that I'm agreeing to pay for a costly service rather than just a co-pay. I'm dealing with some dental stuff right now that's not covered by my plan, and the dentist's office has been extremely clear and forthcoming about costs months in advance. In contrast, this hearing test bill feels like a scam. Does anyone have any recommendations for what I can do from here? Also, does the No Surprises Act help me with this at all?

I had a liver transplant in 2023 at Mayo in Arizona. I live in Oklahoma. I have BCBS of Arkansas through Walmart, where my wife works. Regular lab draws are required and I have a DLO (Quest) and few minutes away from my home. I checked DLO's website which stated they accepted my plan. I got my labs drawn many times over the course of 6-7 months before receiving bills from the lab for the full amount, insurance was paying nothing. After contacting insurance, they said the particular location was not in network. No idea why one would be out of network but other locations of the same company are. However, after conferring with both BCBS and DLO, I was told that BCBS of Arizona is being billed because that's where the ordering provider is from. No one seems to be very helpful on either end as far as getting anything resolved, and there's nearly 20K worth of labs being denied. Does this seem accurate from both the insurance perspective of billing another state's plan as well as why they would deny one location but not another of the same company? Any suggestions on what I should do or how to handle? Thanks!