About LASHUNDA Expertise Billing,Claims, and resolutions to the following insurance agencies: Medicare, Medicaid, Coordination of Benefits, Most Managed Care such as HMO's, PPO's, Medicare Advantage Plans, Governmental Agencies such as Work Comp and Veteran's Administration. I would like questions that are in regards to Billing and Collections from Insurance Companies. I can also accept some questions regarding accounts sent to Medical Collections. Please be advised that I reside in Texas and most of my knowledge is based on how it works in Texas.
Experience I have worked in the Medical field for 15 years. I currently help to coordinate contracts for a physician group in Texas. I am extremely good with resolving issues with commerical insurance companies. I'm an expert in coordination of benefits between Medicare and Commercial insurance companies.
Question Hi, I was hospitalized in Ireland during a vacation 5/25/07-5/31/07. Before my trip I had checked with BCBS about procedure if I needed medical care abroad as I was pregnant with a history of gallbladder problems. I went to ER in one of the authorized hospitals and gave them all my BCBS info and told them that BCBS had direct billing with them, also gave them my case number. Upon my return to US I faxed all my relevant hospital records and discharge reports to BCBS. I was assured by the BCBS rep that she would take care of everything from that point. I did not hear anything else from either parties until Nov 2008 when I received a bill from Irish hospital looking for payment of $10,500! After a lot of coming and going between both parties I received a letter this morning to say that BCBS will not pay claim as it was not submitted by Dec 2007. My question is whether I can be held responsible for the claim when I did everything that I was asked to do and the hospital did not submit the claim in a timely manner? Yours, very anxiously.
Answer Hi Janis. Thanks for your question. I don't want to seem as if I'm taking up for the providers but BCBS can be a little tricky to bill. But...it is totally the providers fault.
Here's my suggestion. I'm not sure if BCBS is still your current insurance plan or not. You didn't mention it. If it is go to your Human Resources department or Benefit Admin at your place (or spouse) of employment. Talk to them to see if they can assist. Most times employer groups have a liason that works between the insurance company and the employer. They might can get the issue pushed through. If this is not your current insurance plan here's another suggestion...contact your local BCBS plan or the plan that administered the plan. Try and bypass customer service because they are trained to tell you the same stuff over and over again. It sound as if you have a case worker at BCBS that was working with you when you traveled. Try contacting her to see if she can assist with the issue. Have you tried calling BCBS yourself to see what the issue is with the claims?
Contact BCBS and find out all the information you can about the claim. BCBS may have been asking for additional information from the patient (you). You should have recieved explanation of benefits over the last few years if the international providers filed the claims.
Now I've got to slap your hand just a little. You cannot assume that the insurance company will take care of everything. You must follow up. Ultimately, if the insurance company does not pay (even after they told you they would take care of everything) becomes your responsibility and it destroys your credit rating.
Call BCBS Member Services...the number should be on the back of your card. Give them the dates of service. Ask them for the status of the claims. If they tell you they were denied then ask them what for. Ask BCBS when did they receive the claims? Usually what happens is the providers has a deadline to file claims with all ins companies. You are trying to find out if the claims were filed timely. If the ins co is requesting additional information to process the claims they would have sent you a letter or an explanation of benefits. You just need to inquire.
If you need additional assistance please re-send an inquiry with which BCBS plan it is, where you live, and what you were told once you called BCBS.
Good luck and I hope some of this information helps.
