Wiki BCBS out State Wild West

[schanderson]

Good Day,

I have an out of State BCBS demanding all medical records and is not happy with what we sent over and refuses to pay the claim. I am a pain management specialist and have given them what we have. My coworker says to just contact her PCP and get medical records. I am sure that should not be done because that just opens a whole can of worms and want to contact the patient to let them know that their plan is being ridiculous and needs to be pushed to accept what is available to them or answer whatever questions they are looking to be answered. I have never given them any notes from another office to get paid before is this some new circle of fire hell that insurance companies are doing now?

Sincerely,

Jumper Carnival

 

[asimmons01]

Hello!
I have worked for offices that have other specialties integrated and the medical records will get crossed by provider. When that happens the records will be denied and the claim will not pay out. So getting records from another office wont work and they wont accept them. Your best bet is to call the insurance company back and ask the rep what is missing from the medical record or what do you need to send in for this claim to be paid. Also ask what is the best way to send these records to them, that could be part of the problem too. They will answer those kind of questions so dont be afraid to ask them to FULLY explain their meaning. I used to be an AR specialist so this really is the best way. Good luck!