BC/BS of TX, You Have a Problem

My psychiatric practice operates on a direct pay model. After the patient pays for the service I hand them a “superbill” and wish them luck. Yesterday I opened an envelope from BlueCross BlueShield of Texas that put me in a bind. Enclosed with my superbill I found a letter (undated, and unsigned) indicating invalid or incomplete subscriber identification numbers prevented processing of the claim. Since a note at the bottom of the form states “Please do not forward this letter to the patient” I decided to call the 800 number listed for “specific questions about this letter.” To my surprise the robot informed me that I had reached the Blues, not of Texas, but of Illinois. Unable to navigate to a human I gave up and started writing this post.

I am “out of network” for all payers. It never ceases to amaze me that insurance companies presume to contact providers, bypassing their subscribers, for these kinds of communication. The subscriber -- not me -- made the claim. The subscriber knows the identification numbers. I do not. Surely the insurance company can look up the subscriber by name and birthdate and contact them directly. Maybe their return address appeared on the envelope. And they presume to tell me not to forward the question to their subscriber (although I must admit that I do not want to be their messenger).

I do not want a relationship with this company. The presumptuous request that I provide the information puts me in a bind. I can either a) follow their instructions and file the letter without showing it to the patient, or b) defy the instructions and forward it to the patient. Choice b) probably helps the patient most, but helping the patient get reimbursement is not my role, nor do I want to help the insurance company.

What would you want me to do?


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