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The Water Cooler
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ACA OBAMA CARE
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<blockquote data-quote="rswink" data-source="post: 3419266" data-attributes="member: 44439"><p>Not all BCBS is the same, when I call for prior auth you have to have all those codes to figure out what they get. It is stupid, 1 plan wanted X-Rays to confirm that they needed the MRI since the previous X-rays were 6 weeks old. Another plan would not approve an MRI without doing CT first. And another lady got her MRI just based on the doctor asking for it. And yet all 3 had BCBS, all 3 ended up with the same diagnosis. But, the price was different for all 3, as well as the number of office visits and tests performed.</p><p></p><p>But, at least BCBS doesn't come back 5 years after the fact wanting to know why you billed for something, then review all your patients and ask for a refund on bill from 5 years ago.</p><p></p><p>I have gotten authorization for tests for people, have the reference number, a fax saying it was approved, and then the diagnostic company coming to us because insurance will not pay, then we find we are not getting paid. And the reasons they give are great, such as we just got a denial because we didn't take vitals on a tele-health visit. We also lost one recently because we didn't chart that we didn't provide education on smoking cessation to a person who was in requesting to go on hospice because he wanted to stop fighting just after Christmas last year, he passed within a month. Some of the crap they pull is just stupid </p><p></p><p>Sent from my Pixel 4 using Tapatalk</p></blockquote><p></p>
[QUOTE="rswink, post: 3419266, member: 44439"] Not all BCBS is the same, when I call for prior auth you have to have all those codes to figure out what they get. It is stupid, 1 plan wanted X-Rays to confirm that they needed the MRI since the previous X-rays were 6 weeks old. Another plan would not approve an MRI without doing CT first. And another lady got her MRI just based on the doctor asking for it. And yet all 3 had BCBS, all 3 ended up with the same diagnosis. But, the price was different for all 3, as well as the number of office visits and tests performed. But, at least BCBS doesn't come back 5 years after the fact wanting to know why you billed for something, then review all your patients and ask for a refund on bill from 5 years ago. I have gotten authorization for tests for people, have the reference number, a fax saying it was approved, and then the diagnostic company coming to us because insurance will not pay, then we find we are not getting paid. And the reasons they give are great, such as we just got a denial because we didn't take vitals on a tele-health visit. We also lost one recently because we didn't chart that we didn't provide education on smoking cessation to a person who was in requesting to go on hospice because he wanted to stop fighting just after Christmas last year, he passed within a month. Some of the crap they pull is just stupid Sent from my Pixel 4 using Tapatalk [/QUOTE]
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