Blue Cross is not covering our clinic visits?

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westonsmom

New member
Hey there,
Has anyone else experienced any trouble with insurance covering clinic visits? We have Blue Cross Blue Sheild Anthem of CT and they are saying that because they are billed as a clinic visit they won't cover it. We got to Rhode Island Hospital for our clinic and the insurance says that if it was billed to them from the physician than they would cover it, but since it is a clinic visit they won't. R.I. Hospital says that they can't bill it from the physician because she is part of the hospital.

I called the CF clinic's in CT and they say they have never had a problem getting payment from Anthem for clinic visits and they bill the same way. So I think I am getting screwed. I called the insurance commisioner and they said that I should write them a letter. Oh Great! I just spend two hours on the phone for three bills and now I have to take time to write a letter. I am so frustrated!

Anyone have any advice? Thanks
 
W

westonsmom

New member
Hey there,
Has anyone else experienced any trouble with insurance covering clinic visits? We have Blue Cross Blue Sheild Anthem of CT and they are saying that because they are billed as a clinic visit they won't cover it. We got to Rhode Island Hospital for our clinic and the insurance says that if it was billed to them from the physician than they would cover it, but since it is a clinic visit they won't. R.I. Hospital says that they can't bill it from the physician because she is part of the hospital.

I called the CF clinic's in CT and they say they have never had a problem getting payment from Anthem for clinic visits and they bill the same way. So I think I am getting screwed. I called the insurance commisioner and they said that I should write them a letter. Oh Great! I just spend two hours on the phone for three bills and now I have to take time to write a letter. I am so frustrated!

Anyone have any advice? Thanks
 
W

westonsmom

New member
Hey there,
Has anyone else experienced any trouble with insurance covering clinic visits? We have Blue Cross Blue Sheild Anthem of CT and they are saying that because they are billed as a clinic visit they won't cover it. We got to Rhode Island Hospital for our clinic and the insurance says that if it was billed to them from the physician than they would cover it, but since it is a clinic visit they won't. R.I. Hospital says that they can't bill it from the physician because she is part of the hospital.

I called the CF clinic's in CT and they say they have never had a problem getting payment from Anthem for clinic visits and they bill the same way. So I think I am getting screwed. I called the insurance commisioner and they said that I should write them a letter. Oh Great! I just spend two hours on the phone for three bills and now I have to take time to write a letter. I am so frustrated!

Anyone have any advice? Thanks
 
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Emily65Roses

New member
I'm on BCBS Anthem or whatever it is for CT as well. I go to a CT clinic, and I don't know precisely how they bill, but I've *never* had a problem having insurance cover it.

Is it because you're going to RI that's causing a problem? I know you were talking about possibly switching to a CT clinic somewhat recently... would that fix the problem? If you're going to switch to a different CF clinic, the younger he is, the better. That way it's just an adjustment for you, not for him.

Mind you, if you can get RI covered, then awesome. But you may need to think switching. Insurance is a major pain in the @ss, as I'm sure you know.
 
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Emily65Roses

New member
I'm on BCBS Anthem or whatever it is for CT as well. I go to a CT clinic, and I don't know precisely how they bill, but I've *never* had a problem having insurance cover it.

Is it because you're going to RI that's causing a problem? I know you were talking about possibly switching to a CT clinic somewhat recently... would that fix the problem? If you're going to switch to a different CF clinic, the younger he is, the better. That way it's just an adjustment for you, not for him.

Mind you, if you can get RI covered, then awesome. But you may need to think switching. Insurance is a major pain in the @ss, as I'm sure you know.
 
E

Emily65Roses

New member
I'm on BCBS Anthem or whatever it is for CT as well. I go to a CT clinic, and I don't know precisely how they bill, but I've *never* had a problem having insurance cover it.

Is it because you're going to RI that's causing a problem? I know you were talking about possibly switching to a CT clinic somewhat recently... would that fix the problem? If you're going to switch to a different CF clinic, the younger he is, the better. That way it's just an adjustment for you, not for him.

Mind you, if you can get RI covered, then awesome. But you may need to think switching. Insurance is a major pain in the @ss, as I'm sure you know.
 
W

westonsmom

New member
After the third call into the health insurance company they finally told me that it wasn't because it was a "clinic" visit but that it was because it was out of network and I had to meet my deductable. Looks like we will be switching.
 
W

westonsmom

New member
After the third call into the health insurance company they finally told me that it wasn't because it was a "clinic" visit but that it was because it was out of network and I had to meet my deductable. Looks like we will be switching.
 
W

westonsmom

New member
After the third call into the health insurance company they finally told me that it wasn't because it was a "clinic" visit but that it was because it was out of network and I had to meet my deductable. Looks like we will be switching.
 
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JazzysMom

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>westonsmom</b></i>

After the third call into the health insurance company they finally told me that it wasn't because it was a "clinic" visit but that it was because it was out of network and I had to meet my deductable. Looks like we will be switching.</end quote></div>

That is a big difference. I was going to tell you to call and get a different rep because I would almost gaurantee that you would get a different answer!
 
J

JazzysMom

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>westonsmom</b></i>

After the third call into the health insurance company they finally told me that it wasn't because it was a "clinic" visit but that it was because it was out of network and I had to meet my deductable. Looks like we will be switching.</end quote></div>

That is a big difference. I was going to tell you to call and get a different rep because I would almost gaurantee that you would get a different answer!
 
J

JazzysMom

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>westonsmom</b></i>

After the third call into the health insurance company they finally told me that it wasn't because it was a "clinic" visit but that it was because it was out of network and I had to meet my deductable. Looks like we will be switching.</end quote></div>

That is a big difference. I was going to tell you to call and get a different rep because I would almost gaurantee that you would get a different answer!
 
F

folione

New member
I've concluded from my experience that insurance companies design their procedures to deny first and ask questions later...it's in their interest to delay as long as possible making payments. It's absurd, of course, but I think you have to talk to insurance repr.s knowing that they are NOT there to help you solve problems...and you've got to keep poking them with different versions of the same question until they're forced to reveal the real problem. The most ridiculous one I had once was a claim was rejected because the billing code had an extra zero on the end of it and had 1 too many digits...a 5 year old would have recognized it as a typo but not the insurance company and all I got back was "not a covered expense.."
 
F

folione

New member
I've concluded from my experience that insurance companies design their procedures to deny first and ask questions later...it's in their interest to delay as long as possible making payments. It's absurd, of course, but I think you have to talk to insurance repr.s knowing that they are NOT there to help you solve problems...and you've got to keep poking them with different versions of the same question until they're forced to reveal the real problem. The most ridiculous one I had once was a claim was rejected because the billing code had an extra zero on the end of it and had 1 too many digits...a 5 year old would have recognized it as a typo but not the insurance company and all I got back was "not a covered expense.."
 
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