Hi all, I recently moved, got a new gastroenterologist, and switched to Blue Cross Blue Shield insurance. I specifically went to the new doctor to get a prescription for Viberzi for my IBS. I've been on this medication for four years and knew the new insurance would require prior authorization. Long story short, my prior authorization was denied because the insurance company said my medical history wasn’t documented. I was confused since I had already submitted my past medical records to the new doctor. When I called the office to check, they told me they *can’t* include previous medical records because they were from before I became a patient there. They said they are going to submit it again and it will go to a peer-to-peer next. And I asked if the doctor will submit my medical history then. And they told me "He doesn't need to send your medical history. He's a physician." I’m really frustrated and not sure what to do next besides hoping the peer-to-peer thing works. Has anyone dealt with something similar? Can a doctor really not use past medical records for prior authorization? Any advice?

I went to a urology visit at UIC in Chicago. The whole visit was around 10 minutes, no longer, since I was called in: blood pressure and oxigen check, a few questions about my health history and then came in the doctore that in two minutes, without even using special pieces of equipment, gave me the diagnosis. Only few weeks ago I recevied the bill and surprisingly I was billed twice: one bill for the doctor service and one for the use of the infastructure tislef. Basically the doctor just "rent" the room and equipment and provides the service. For the first bill, the total was covered by insurance excpet a small co-payment ($40), but the second one is covered only partly . It was $460 and after reductions, I have to pay out pocket, 250$. The code associated with this item is 99204: "New patient office or other outpatient visit, 45-59 minutes, Level 4" (https://www.ama-assn.org/practice-management/cpt/cpt-code-99204-new-patient-office-visit-45-59-minutes#:\~:text=Additional%20CPT%20resources-,CPT%C2%AE%20code%2099204%3A%20New%20patient%20office%20or,outpatient%20visit%2C%2045%2D59%20minutes) If you read thorugh the link above, this code should be applied when: "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." Basically, none of these createria were met. Even if I descalate to Level 3, it still require 30-44 minutes and a thoroughly examination of past and current conditions. Now, what actions would you suggest me to do? Trying to reason with the hospital itslef or can BCBS help me with this matter? Fortunately, I can afford to pay this bill. But it is just frustating that it's literally a mafia, a scheme out there, and nobody does nothing. I can't imagine the people living paycheck by payecheck and being frauded by private health.

I went to NYU langone raadiology lab (its inside hospital) for a ultrasound before the ultrasound i looked up the cpt code on the bcbs website and it gave me an amount allowed of like 200$ before deductions, and i was okay with that now i got the bill, and the amount allowed is like 900$ i called the insurance and they said its because the lab billed under the lab but not the doctor itself -- the amount estimated on the website is under a doctor . bcbs does not know what is the amount allowed under the "lab" i dont know if this is normal, but it was my first ultrasound and i dont know what to do. if i ask nyu langone to bill under a doctor will they do that? it was just intern/PA that did my ultrasound so does that even count? what should i do in this case?

I started getting calls asking if I am accepting new patients. I just said, I am sorry but you have the wrong number. After the fourth call I asked who they were trying to reach. I was told the name of the doctors office and read the number to me. It is my personal number and I have had it for 22 years. I went onto Blue Cross Blue Shield site and looked up the office and it does show my number. I contacted BCBS and they told me that they looked it up online and it is a different number listed there but they cannot do anything. She then told me to call the office and see if I could get them to change it in the providers portal. No one is returning my calls from this office, so no help there. I can't not answer my phone as I use it for my business. Any suggestions or insights would be greatly appreciated.

I was charged $2500 for an ultrasound required for my high risk pregnancy. My insurance provider (BCBS of IL) states that that my portion owed is $0, due to "**Discounts Applied -** Your BCBSIL plan has negotiated cost savings for you with your provider. You may still need to pay part of the bill. Check Details of Services for details of what you may owe." Under details of services, everything states I am responsible for $0. There is no copy of the EOB for this charge - every time I look it says it is "not available at this time." In the meantime I have received a bill from the in-network hospital, stating I am responsible for the full $2500 because my insurance did not cover it. I actually have 3 similar bills just like this, but only including one for simplicity of questions asked. I plan to call my BCBSIL tomorrow, but what are some questions I should ask here? Should I be verifying my cost owed is $0 and then having them contact the hospital directly to refute the bill? Or do I need to contact the hospital directly? Or is there a chance I am actually responsible here? I haven't seen this "discounts applied" verbiage before, so I am a little confused.

Hi everyone, the title is basically it. I have a marketplace plan starting last year. I signed up for autopay, or so I thought. Turns out not a cent came out after the first payment. There was zero notice. They said they snail mailed me something but I'm in the process of moving and my mail comes to my parents house. Not to mention if I saw something I would have assumed it was a monthly statement and tossed it. They had my email, my phone number, i received multiple emails but not a word about my account. I have a medication I order about once a month that costs around 2-3k without insurance and I'm racking my brain to figure out if it shipped after january. TLDR - bcbs told me that my account is just termed. I cant reactivate and need to contact the marketplace. Does anyone have any advice?