ComplaintsforBlueCross BlueShield of Louisiana

• Initial Complaint

  04/26/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  RxMbr ID #***-***-****Member Name: ****** ****** DoB: ********** On November 18, 2021, my daughter (**** ******) performed IN-OFFICE SURGERY at ******* hospital – New Orleans. ******* reported the surgery as follows: Place of surgery: IN-office surgery, Patient type: Outpatient. I have been told by ******* that there is an amount of $768.89 that is not covered by my insurance. I called my insurance company in early of 2022, I have been told by the insurance company’s agent that this amount should be totally covered by my insurance since the surgery is IN-OFFICE SURGERY and it should not be taken from my co-pay or my deductible. The Agent told me that since the surgery was reported (claimed) as an IN-OFFICE SURGERY, the type of patient should be reported as IN-OFFICE PATIENT. The agent told me that I will get a call from my insurance once they pay this amount to ******* and solve this issue. I never get any call !!. At the same time, I called ******* hospital, and they told me that they only report the type of patient to be out-patient or in-patient and they don’t have what I have been told by the insurance company (IN-OFFICE PATIENT), and since the surgery was in office, they reported the type of the patient to be out-patient since my daughter left the hospital immediately after the surgery. I called my insurance company many times try to explain to them what I have been told by ******* and they promise to solve this issue and call me back ? They never called me back. On March 30, 2022, I called the insurance company and I have been told (literally) that since this surgery is IN-OFFICE SURGERY, it should be covered by my insurance and not from my co-pay or my deductible. The lady at the insurance company said she will communicate with me after she solve this issue and (as usual) she DID NOT!! Please see the attached file for more explanation on my case. Thank you

  

  Business response

  06/07/2022

  Good Afternoon,

  Please find attached the response to this complaint. Please do not post any information contained in this email to your site as it contains member PHI. If there are any questions please feel free to contact us at the email on file.

  Thanks, 

  Kendra *****

  Compliance Consultant - Regulatory Appeals

  Customer response

  06/08/2022

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID 17105023, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ****** ******

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