[cunch]

I purchased a major medical policy directly from BCBSFL in Jan. I was told by the salesperson if I went to a in network doctor I would pay the BCBS allowed rate. I specificaly ask this question when I bought the policy. I later found out this is not the case. When I called my salesman he apologized and offered to sell me a better policy. I reported this to the state of Florida Financial Dept. No response to this point. I do not understand why my doctor will accept 71.00 from BCBS but charges me 117.00 when I am paying cash. I will be looking for a new doctor!

[Mikeod]

Originally Posted by cunch

I purchased a major medical policy directly from BCBSFL in Jan. I was told by the salesperson if I went to a in network doctor I would pay the BCBS allowed rate. I specificaly ask this question when I bought the policy. I later found out this is not the case. When I called my salesman he apologized and offered to sell me a better policy. I reported this to the state of Florida Financial Dept. No response to this point. I do not understand why my doctor will accept 71.00 from BCBS but charges me 117.00 when I am paying cash. I will be looking for a new doctor!

You do understand that physicians agree to accept a payment less than their regular charges in order to participate in the program. Those without coverage pay the regular rate. Most of the time, insurance plans pay about 80% of the "usual and customary" fee. In this case, it appears the reimbursement rate is about 60%.

[blueash]

If you have a policy that covers the service you received, then the in network provider must accept the allowed amount specified by the carrier. If you go to an in network provider and have a non-covered service (eg Botox from an in network dermatologist) then they can charge whatever they want and you are responsible. If you have a policy that only covers in hospital charges, and you see a doctor in the office, again you are fully responsible. The fact that they are offering you a "more expensive" policy suggests the one you have does not cover as many variables as you thought it did. If you call the 800 number on the back of your card, a rep will be able to walk you through the exact reasons. I am of course assuming that you told the doctor you have BCBSF and gave them your card, and asked them to bill the carrier to determine the allowable not just asked them to charge you the BCBS rate.

[skip0358]

Info is correct however some of the Medical Groups have contracted with a company to do they're billing. That company is paying the medical group at 100% and then billing the insurance. The insurance is paying their discounted rate and this billing outfit is coming after you for the remainder. It violates the contract you have with the medical insurance but the billing company wants the difference because that's how they get paid. I'm battleing with them right now. actuallt threatened to take me to court. Very annoying. only happens with one of my companies though.

[TomW]

I have medical expense insurance with two companies that include a clause in their provider contracts that do not allow balance billing. In at least two instances I have been able to get what is generically called a "balance billing letter" sent by the insurance company to a medical provider who attempted to bill me for the difference between their charges and what they agreed to accept from the insurance company. The statement we all sign saying we will be responsible for the difference is superceded by the contract between the insurance company and the provider. But, not all arrrangements have this feature and it might be something to check for anyone shopping for insurance.