Preferred Provider Caveat
Upon opening my mail a couple days ago I find a bill from the anesthesia group that provided services on July 25th for my husbands shoulder surgery.
The fact that this was the first time I had seen the bill is a story in itself, the short version being that the office said they use the addresses provided by the hospital.
Very curious I thought since we had received the hospital and surgeon bill without any problems.
The bill was showing that Blue Shield had sent the money to the patient, so I called my husband in Alaska to see if he had received any check.
Of course, just as I thought the answer was no.
I immediately called the office number and left a message since they were out on a snow day.
The following day the lady from the billing office called with the attitude that I was a "dead beat" right off the bat.
I explained that I had never seen the bill until the previous day and she stated they had also mailed a certified letter which had gone to an address prior to our moving into our home in August 2004.
She further explained that she was going to be mailing another certified letter and the bill of three charges for a total of $2778.
79 would need to be paid prior to February 8th or be turned in for collection.
I faxed the bill and emailed information to my husband regarding the matter along with the Alaska Blue Shield number he needed to get the needed Explanation of Benefits, inquire about this check for $930.
08 and find out what if anything we owe to the anesthesia group.
Of course, the check was also sent to the wrong address and later we find it had been returned to Blue Shield and they will now issue another.
The answers we received regarding this bill are alarming to say the least.
You can look for surgeons, hospitals, doctors from your Preferred Provider Directory and still be liable for large bills for other services while undergoing a procedure from outside service providers contracted to the hospital such as an Anesthesia Group or Radiologist.
You sign stating you are responsible if the services if the provider is not a Preferred Provider.
My husband asked if it was not a reasonable expectation that after choosing the above from the Preferred Provider List that everyone involved is a Preferred Provider and Blue Shield told him "no not necessarily.
" We further found out that when the insurance company is in this case paying the patient directly that the "group" has lost their standing as a Preferred Provider and no monies will go directly to the provider.
In addition; of the three services listed on this bill, one had already been paid to the hospital in the amount of $513.
25 by Blue Shield and another charge for $1029.
54 was for a botched procedure since the shunt was unable to be placed into the neck after three attempts.
It ends up that the amount owed by us on this bill is only $103.
00 after Blue Shield cuts another check for the $930.
08 since now the group is accepting what the insurances pay in order to get back on the Providers List.
Not looking good for them I say, charging for procedures already paid to the hospital, having incorrect addresses and charging for procedures not completed does not look good.
Lessons learned:insist on knowing if everyone involved is a Preferred Provider for a couple reasons, 1) money 2) fraud 3) competency.
Do you ask if all services are Preferred Provider approved prior to signing?You should.
The fact that this was the first time I had seen the bill is a story in itself, the short version being that the office said they use the addresses provided by the hospital.
Very curious I thought since we had received the hospital and surgeon bill without any problems.
The bill was showing that Blue Shield had sent the money to the patient, so I called my husband in Alaska to see if he had received any check.
Of course, just as I thought the answer was no.
I immediately called the office number and left a message since they were out on a snow day.
The following day the lady from the billing office called with the attitude that I was a "dead beat" right off the bat.
I explained that I had never seen the bill until the previous day and she stated they had also mailed a certified letter which had gone to an address prior to our moving into our home in August 2004.
She further explained that she was going to be mailing another certified letter and the bill of three charges for a total of $2778.
79 would need to be paid prior to February 8th or be turned in for collection.
I faxed the bill and emailed information to my husband regarding the matter along with the Alaska Blue Shield number he needed to get the needed Explanation of Benefits, inquire about this check for $930.
08 and find out what if anything we owe to the anesthesia group.
Of course, the check was also sent to the wrong address and later we find it had been returned to Blue Shield and they will now issue another.
The answers we received regarding this bill are alarming to say the least.
You can look for surgeons, hospitals, doctors from your Preferred Provider Directory and still be liable for large bills for other services while undergoing a procedure from outside service providers contracted to the hospital such as an Anesthesia Group or Radiologist.
You sign stating you are responsible if the services if the provider is not a Preferred Provider.
My husband asked if it was not a reasonable expectation that after choosing the above from the Preferred Provider List that everyone involved is a Preferred Provider and Blue Shield told him "no not necessarily.
" We further found out that when the insurance company is in this case paying the patient directly that the "group" has lost their standing as a Preferred Provider and no monies will go directly to the provider.
In addition; of the three services listed on this bill, one had already been paid to the hospital in the amount of $513.
25 by Blue Shield and another charge for $1029.
54 was for a botched procedure since the shunt was unable to be placed into the neck after three attempts.
It ends up that the amount owed by us on this bill is only $103.
00 after Blue Shield cuts another check for the $930.
08 since now the group is accepting what the insurances pay in order to get back on the Providers List.
Not looking good for them I say, charging for procedures already paid to the hospital, having incorrect addresses and charging for procedures not completed does not look good.
Lessons learned:insist on knowing if everyone involved is a Preferred Provider for a couple reasons, 1) money 2) fraud 3) competency.
Do you ask if all services are Preferred Provider approved prior to signing?You should.
