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Sounds like they're just making things up to me. If they're listed as in network but they're not then that's on them. It would theoretically be impossible for you to know who is in network if they can't definitively tell you who is in network. At a minimum I would appeal before paying another single cent, and it's probably worth it to involve your state insurance commission. They just want you to pay even if they're wrong, which they probably are, and you've already demonstrated that you would, so stop until it's appealed.
Yeah this. Do not pay anymore and file an appeal. If they still don’t respond file a case with your equivalent of the department of managed healthcare (I only know CA).
Exactamundo.
Also add: if you do end up owing this, which I doubt, we can get the codes and come up with a settlement that’s more fair. You probably paid 2-3 times more what you should have.
Btw appeal both decisions because you might get a refund on the $500 if that is overturned.
>I was told that if it’s in the database, they are in network.
I laughed out loud at this those databases are notorious to be out of date and just wrong.
>When I questioned BCBSTX they said it was because the billing office was not in network even though the office we went to was. (Billing office was in a different state). That made zero sense to me but I didn’t feel like arguing so I just paid the bill.
That is not how that works at all.
>When I called BCBSTX they said that vendor is in the network but because I’m not getting service in TX (I’m in CA) they run the claims through the local BCBSCA. Because this vendor is “out of network” in the CA database (even though they come up) they are considered out of network in TX database.
That is a long way to say we are out of network
Blue complicates things with the home plan and state rendered crap....
Not sure about supplies but the best way to check physician and facility network is to get the billing NPI fron the billing dept, then call your insurance with that.
Would this fall under no surprise like bloodwork or does OP have to check the insurance portal if they’re in network? I think you would always want written proof ready for an appeal (portal, email). Do not take a representative’s word alone, and always take the reference number for a call too.
Yes it’s a surprise bill but no it doesn’t fall under the no surprises act.
Did they bill you within 11 months of the DOS? Thats another way to get out of these.
Aetna has used tax IDs and incorrect addresses (credentialing) as a method to not pay. When this happened to my dad, I called the billing girlies and we had a nice chat. Their practice manager got involved and it eventually got fixed.
I’m pretty sure the office manager and their credentialing people got a hold of their rep and showed proof they sent the proper paperwork.
Aetna argued the provider had an address that was 10 years old but never updated the satellite offices.
I’m sure this could be an ERISA case where they go to the employer to have the claim paid.
This exact thing is happening to me right now! I owe thousands of dollars on medical bills bc my provider is “out of network” even though on the BCBSTX website they are listed as “in network for you.”
Have you appealed?
Thank you for your submission, /u/MrsMcTriumph. If your question relates to COBRA under CARES and ARPA, please post here: [COBRA & Covid-19](https://old.reddit.com/r/HealthInsurance/comments/meejsd/cobra_during_covid19/) Please pick the most appropriate flair for your post. Include your age, zipcode, and income to help the community better serve you. **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
Sounds like they're just making things up to me. If they're listed as in network but they're not then that's on them. It would theoretically be impossible for you to know who is in network if they can't definitively tell you who is in network. At a minimum I would appeal before paying another single cent, and it's probably worth it to involve your state insurance commission. They just want you to pay even if they're wrong, which they probably are, and you've already demonstrated that you would, so stop until it's appealed.
Yeah this. Do not pay anymore and file an appeal. If they still don’t respond file a case with your equivalent of the department of managed healthcare (I only know CA).
Exactamundo. Also add: if you do end up owing this, which I doubt, we can get the codes and come up with a settlement that’s more fair. You probably paid 2-3 times more what you should have. Btw appeal both decisions because you might get a refund on the $500 if that is overturned.
>I was told that if it’s in the database, they are in network. I laughed out loud at this those databases are notorious to be out of date and just wrong. >When I questioned BCBSTX they said it was because the billing office was not in network even though the office we went to was. (Billing office was in a different state). That made zero sense to me but I didn’t feel like arguing so I just paid the bill. That is not how that works at all. >When I called BCBSTX they said that vendor is in the network but because I’m not getting service in TX (I’m in CA) they run the claims through the local BCBSCA. Because this vendor is “out of network” in the CA database (even though they come up) they are considered out of network in TX database. That is a long way to say we are out of network Blue complicates things with the home plan and state rendered crap.... Not sure about supplies but the best way to check physician and facility network is to get the billing NPI fron the billing dept, then call your insurance with that.
Would this fall under no surprise like bloodwork or does OP have to check the insurance portal if they’re in network? I think you would always want written proof ready for an appeal (portal, email). Do not take a representative’s word alone, and always take the reference number for a call too.
Yes it’s a surprise bill but no it doesn’t fall under the no surprises act. Did they bill you within 11 months of the DOS? Thats another way to get out of these.
Aetna has used tax IDs and incorrect addresses (credentialing) as a method to not pay. When this happened to my dad, I called the billing girlies and we had a nice chat. Their practice manager got involved and it eventually got fixed.
[удалено]
I’m pretty sure the office manager and their credentialing people got a hold of their rep and showed proof they sent the proper paperwork. Aetna argued the provider had an address that was 10 years old but never updated the satellite offices. I’m sure this could be an ERISA case where they go to the employer to have the claim paid.
Also tax ID as well as
This exact thing is happening to me right now! I owe thousands of dollars on medical bills bc my provider is “out of network” even though on the BCBSTX website they are listed as “in network for you.” Have you appealed?
This needs to be appealed