Snobdds
Elite Member
Every year I go through coverage issues with my plans. Every year. I realize Health Care plans are complex. But when you have the same procedures done year after year, and you have to engage BCBS about why one visit is covered and another is not, there is a serious problem.
I don't trust anything, the minute details always fouls up some higher-up plans.
Insurance pays based on what the clinic codes the procedure as.
We have very complex systems that pays via a matrix on elected benefits and where you are at against a cost share. We don't have the time to micromanage payouts. It's not a human there reviewing each claim...That was the 80's.
99% of the time, billing issues start and end with the way a provider codes a visit. That is where the human part of this lies and most of the mistakes are the results of human interpretation.