Blue Cross Blue Shield Insurance Issues

I hate to blog about insurance companies and approvals but lately I have received a couple of negative reviews based solely on the facet that the patient’s insurance company did not approve their medications or their procedures. I had one patient give me a two star rating because his Tramadol ER was denied by the insurance company. The insurer, BCBS told the patient that it was our fault that the medication was not approved. I am not sure how it can be our fault since we don’t approve anything, nor do we have the power to do so. All we can do is fill out the prior authorization form and hope for the best. If the insurer denies the medication then there isn’t anything we can do to change that. Nonetheless, the patient blamed us for Blue Cross’s denials. The second negative review was a patient that underwent a single Lumbar Epidural injection as requested by the spine surgeon. Again, the insurer was BCBS and they gave us a prior authorization number which means we can move forward. The procedure was done and then after the facet, BCBS decided that they would not pay for the procedure. The patient was not hounded about it but she returned a year later for a follow up and was told that she had a balance for the procedure. She stated that since the insurance company didn’t pay us that we should get nothing. She then stormed out of the office and gave us the bad review because her insurance wouldn’t pay for services rendered. Again, we do not have any power over the insurance company and their payments or approvals. It is out of our control. As for getting paid for services rendered, if a auto shop worked on your car and the insurer decided not to pay the shop then I am pretty sure they would expect you to pay for the services rendered. I am unsure why the patient felt that we should work for free. Ironically, the patient never paid for the services and I still have a bad review. So she ended up getting her injection for free but still is not happy. The last bad review was a patient that I saw once and then one week later gave me a bad review because we were having difficulty getting her epidural injection approved. We did all the appropriate paperwork but it was denied. The patient states that the insurance company told her that it was our fault that it wasn’t approved. Ironic since after the patient called they have the power to approve it if they wanted but instead blamed it on me the doctor who has no authority to approve anything. This patient came into our office after we called her to tell her since she gave us a negative review that we would not see her again. She was yelling in our lobby with patients there amazed that we would not get her procedure done even after she gave us a one star rating. Again, she had BCBS. The common theme is BCBS being each of these patient’s insurer. BCBS now is the main Affordable Healthcare Act insurer and in keeping costs low, they use a third party vendor to approve everything. Thus, BCBS doesn’t approve anything anymore. When the patient calls BCBS they always tell the patient that it is never the insurers fault and that it is everyone else’s fault that something didn’t get done. The third party vendor has specific guidelines that must be followed for low end BCBS insurance plans and generally we have found that they are very difficult to work with. Many of my cohorts no longer accept the Blue Select or Blue Options type plans simply because of how difficult it is to work with them. The higher end BCBS plans such as Federal Blue and most state plans are still reasonable plans. Nonetheless, I want all the people out there to realize that we doctors do not have any power over your insurance companies and we have no power to get things approved. The insurer may tell you that it is our fault but how can it be our fault when they are the one’s who approve things. It is disingenuous for the insurer to tell you that all the doctor has to do is fill out this form or do a peer to peer review when the reality is that they aren’t going to approve it anyway. They are simply making more hoops to jump through in an attempt to blame others for their poor service. So I have three bad reviews with one or two stars from people that I only saw once and each of them thought I did a good job and actually say that in their review but gave me the poor rating because their insurance stinks and they are using me as the scapegoat. I wouldn’t care but people nowadays are taking reviews seriously and for every one star review you get it take four 5’s to get you back to a “b” rating. The last person said to me that she didn’t give me a bad review but she gave my office the bad review. She didn’t give me a five and then complain of my staff. The one star she gave me alters my score since obviously the rating is not of my office but me and thus the one star is under my name and not my staff. It is like giving a student an “F” rating but telling them that they did a great job. an “F” is still an “F”.

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