This is from my mailbox today from a doctor in California explaining what’s been going on with Blue Shield.  We have heard many stories about not knowing who’s in network and who’s not and here’s a case of where the doctors signed up to be in network and are out of network.

I covered before the fact that both Blue Cross and Blue Shield would be paying imagedoctors 20 to 30 percent less for patients who bought via the exchanges.  I have even told people that just so they were aware of that fact.  Now after the doctors provided care and are I guess “out of network” checks are going to the patients and the doctors are trying to collect their money for service already rendered.  This is yet one more bunch of broken algorithms with systems that can’t route reimbursement checks.   This is the biggest problem with health insurance today are all the complex IT infrastructures that need to work together and move the data and in this case, it’s not getting done. 

Obamacare - One Big “Attack of the Killer Algorithms” No Matter Which Direction You Turn, Compounded With a Lot of Government and Consumer “Algo Duping”….

In addition the doctor said he’s also being paid by United Healthcare at rates lower than Medicare and I have heard that now from around a half a dozen doctors.  Here’s a bit of what the doctor has to say….and now the doctors don’t have much choice other than to have the patient pay up front and send the bill to Blue Shield.  This really begins to put a bad wedge between the doctors and the patients, neither of which are at fault.  Is this the part where we bring Richard Simmons out for encouragement:)  BD 

“Blue Shield announced to all that for their Covered California Health Plan all its Blue Shield providers are on the plan. I had patients sign up specifically because they saw I was on the plan (the same happened to other physicians as well). However once the plan went into effect most of the physicians contracted with Blue Shield were no longer listed as contracted providers.

Furthermore after we provided services to  these patients the Explanation of Medical Benefits from Blue Shield showed that we were discounted some 20-30% of our previously paid services and the check was now going to the patient and not the provider.   We have been trying to get these checks from the patients who love getting these Blue Shield checks and keeping them.
As physicians are finding this out they are mad and are starting to demand payment up front from the patient and give them a superbill so they can bill Blue Shield. What a mess.”


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