Unable to Accept BCBS

Effective April 13, 2017 we can no longer accept BlueCross BlueShield policies as payment for services rendered.

For reasons yet to be explained by BlueCross BlueShield of Georgia (BCBSGa), BCBSGa apparently terminated our contract effective March 2, 2017. We became aware of this on March 23, 2017 when the first claim denials for dates-of-service on or after March 2nd began to arrive. We spoke to our provider network representative on March 23rd, who informed we are not terminated. After getting no resolution via individual policy customer service representatives (CSR), our provider network representative sent our issue to the “escalation” area for resolution on March 29th. To date we have received no response.

Anyone who has had any issue with a claim will attest to the sheer utter sense of hopelessness and frustration that comes with trying to get help from a third-party payer CSR. We, too, are now in such a situation. Let it not surprise you that we, as a provider, are treated no better than you by third-party payers, and—not being the customer—are more often than not treated even worse.

As a small business we can no longer absorb the loss of seeing patients for whom we are not being paid. Until further notice BCBSGa policy holders cannot use their policy as payment for services rendered. You may continue to receive services as a self-pay patient. If BCBSGa resolves this issue, we will file a claim(s) for the date(s)-of-service, and reimburse you accordingly.

All BCBSGa patients who have dates-of-service on or after March 2, 2017 will be billed for their denied claim(s). We know you are not going to like this, but, as we make plain in our Financial Agreement, you remain at all times financially responsible for all services received in our clinic, and you alone must assume the risk of your third-party payer not paying. As third-party payers are so often wont to state: a policy ID card is no guarantee of payment. Our only advice to you is to call BCBSGa—perhaps several hundred angry patient families calling will prompt BCBSGa into action.

Update, April 13, 2017: Wow! We are truly humbled by the tremendous outpouring of support from so many of our patient families. And, we are grateful for all of you who called BCBSGa today. Your voices were heard!

Late this afternoon, we received a response from BCBSGa in which they admitted to erroneously terminating Dr Jill effective March 2, 2017, due to their “systems” being updated for “some reason” to request the cancellation. Yes, we are demanding a full accounting as to why. The request to restore her status was implemented this morning, April 13th, and—in typical third-party payer fashion—BCBSGa implied it will be a months long process to restore her standing and to resume payment of claims. As to any denied claims, BCBSGa will reprocess all impacted claims.

For those who did talk with a BCBSGa customer service representative (CSR), you know they were as confused as you. We lost count of the number of CSRs that called us wanting an explanation for why we are telling patients we are terminated/out-of-network, when their screens are telling them we are an active, in-network provider. The reason for that confusion is that BCBSGa did not follow its own procedures. Had we been properly terminated, had our issue been properly sent to “escalation”—as we were told on March 29th—our file would have been flagged and tagged with the proper information for CSRs to give patients when they called. Why the CSRs were telling you—and us—that our billing was at fault is unknown.

We do regret the confusion and turmoil this situation is causing our patient families. However, as of April 12th, we had no response from BCBSGa, and more importantly we had no indication from BCBSGa if or when a resolution could be expected. As a business we cannot provide our services indefinitely without being paid. Once we are confident that BCBSGa is acting in good faith to correct its error, we will resume accepting BCBS policies—and that should be soon.

Again, we are truly humbled by the outpouring of support and grateful for your action—your voices were heard!

Update, April 13, 2017: From the you-cannot-make-this stuff-up-department: within an hour of getting the BCBSGa response, we received an invitation from BCBSGa to participate in a survey for us to tell them how they’re doing because “[BCBSGa’s] relationships with physicians/clinicians are critical.”

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