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  1. #21
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    23,196

    Default Re: Error in Treatment Approval Dates

    Well done. Glad to hear it. Merry Christmas!

  2. #22

    Default Re: Error in Treatment Approval Dates

    I received a letter from the Hospital about the $14k charge. They are asking me to get BCBS to pay it, or provide an EOB to them. I called and they asked for a copy of the EOB. My EOB shows me as responsible for $0 which the insurance company has also stated when I contacted them. The Hospital says they have an EOB showing customer responsible for $14k. They also said they made an adjustment to the bill, bringing my amount due down to $2k. BCBS adjusted another separate claim from the hospital down from $21k to less than $200. I would expect they would have also adjusted this claim to less than $200 as it was also in network. So I will mail them the EOB by certified mail. Any guesses as to what their next response will be?

  3. #23
    Join Date
    Feb 2008
    Posts
    941

    Default Re: Error in Treatment Approval Dates

    claims adjustments will depend on what the services are and how they are specifically contracted to be paid. Just because one was less than $200 doesn't mean they all will be.

  4. #24
    Join Date
    Jan 2006
    Posts
    37,027

    Default Re: Error in Treatment Approval Dates

    The insurance provider creates the eobís so if they have one as they claim, so does the insurance company. It may be there are more than one eob for a given claim especially if it was reconsidered and recalculated

    ask the hospital for a copy of theirs. The latest date wins.

  5. #25

    Default Re: Error in Treatment Approval Dates

    Hospital is appealing for 2nd time. They have received my EOBs, but did not want to comment on them. Just said it would take up to 6 weeks to scan them into my records... I was wondering if all the previous comments are also applicable for a self-insured plan, which this is. US Dept Labor governs them, and the state laws do not generally apply.

  6. #26
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    23,196

    Default Re: Error in Treatment Approval Dates

    Since this is an issue regarding the contract between BCBS and the provider, whether the plan is self-funded or fully funded is immaterial. If it were a question of whether x procedure was a covered procedure, it might matter. Since that's not the issue, it doesn't matter a hoot. It's not a state law or a Federal law issue; it's a contract issue.

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