I am getting some MRI's done at a outpatient facility and wanted to get an estimate by my insurance on my copay. My insurance asked me to get the NPI /taxid for the radiologist that will be doing the MRI so they can get the best estimate. I have BCBS I contacted the outpatient facility (NJ imaging network), and they gave me an NPI number but thats the NPI nubmer of the facility. I asked for NPI number of the radiologist, but they said that they bill under the facility, not the radiologist. How am I supposed to get an accurate estimate here? Also by "provider" billing I mean physician billing

What am I missing here? It looks like Anthem BCBS is acknowledging my provider is in-network and then processing it as out-of-network. * Provider has been processed as in-network for visits both before and after the visit in question, always with a $30 copay and no balance. This was another routine, non-emergency visit with the exact same provider. * EOB clearly says in big bold print that "Going to this doctor uses in-network benefits" and elsewhere has the words "(in your plan)" after the provider's name. * EOB shows no copay, a portion applied to my deductible, and a balance in the "Your total cost" column. * EOB gives a reason code: "015: The amount shown here is more than your plan allows for this care. If this was not an emergency, the doctor/facility might bill you for the difference between what your plan allowed and what the doctor/facility charged." How is this possible for an in-network provider? It seems this EOB is just contradictory on its face. I've been trying to get them to fix it, but haven't had any success yet. Any advice?

My husband and I signed up for BCBS of Illinois PPO+ plan through his work this year. I started seeing a physiatrist who was in network. When my claim was submitted, they only approved a discount from $360 to $219 leaving me having to pay $219 out of pocket. I previously had United Healthcare from my last company and with that insurance my physiatry appointments were only $30. I have read through our policy agreement but have to admit, I have no idea what I am reading. Can someone help explain what is different between my currently BCBS plan that only approves a discount vs other plans who only make you pay the co-pay? Thank you!

I got diagnosed with sleep apnea and I was delaying my treatment because I found out that its very expensive. After a few months, the cpap company based in Houston, TX reached out again that my deductible has been met and I just owe 171$ and then insurance will take the charges. After I started my sleep apnea treatment, I got the call again from the medical company that they made a mistake on their end and the benefit information was not correct. So now, they are asking me to pay 45$ for supplies and 65$ for cpap rental every month till the payments are complete. I am just a loss of what the hell is this! I get screwed up and left with more charges for a treatment which was quoted wrongly to me. I called Blue Cross Blue Shield OF TX and they said they cannot help me. My current insurance is ending in one month and I am changing insurance from next month. So, it doesn’t make sense why pay deductible towards an insurance which will not be there in 30 days. What are my rights?

I am getting some MRI's done at a outpatient facility and wanted to get an estimate by my insurance on my copay. My insurance asked me to get the NPI /taxid for the radiologist that will be doing the MRI so they can get the best estimate. I have BCBS I contacted the outpatient facility (NJ imaging network), and they gave me an NPI number but thats the NPI nubmer of the facility. I asked for NPI number of the radiologist, but they said that they bill under the facility, not the radiologist. How am I supposed to get an accurate estimate here? Also by "provider" billing I mean physician billing

I'm honestly at my breaking point dealing with BCBSNC. I’ve had multiple claims denied that should be routine — and I’m exhausted from trying to get clear answers. Recently, I had in-network bloodwork done that was ordered by my doctor. BCBS denied the entire claim — not even applied to my deductible — and there was no EOB at first. The exact same tests were processed last year with no issue. In Dec. I had a bad sinus infection, I went to urgent care, and even though the provider billed it correctly as urgent care (POS 20), BCBS processed it as outpatient hospital and denied the appeal. Last year, I also got stuck with a $1,300 bill after seeing a cardiologist who ordered a stress test at a local hospital. That claim was denied too, because they classified it as an outpatient hospital visit — even though it was a specialty care appointment. I’ve submitted appeals, contacted billing departments, and chased down paperwork, and BCBS just keeps giving vague, inconsistent responses. I haven’t contacted HR yet, but I’m seriously considering it, along with a complaint to the Department of Insurance. I’m using in-network care and following the rules. I just don’t know what else to do at this point. Has anyone else dealt with this kind of mess?

Hey y'all This is my first time posting here. I am going to be starting a job here soon where I need to get my pre exposure rabies vaccine prior to starting. The issue I am having is my health insurance (Anthem blue cross blue shield) doesn't cover it and it is gonna put me down like $800 with finical compensation from my employer. I live in Kentucky. I was wondering if anyone has any advice or ideas of ways I could try to get that price down. I'm not sure of theirs any good answers but figured I would ask. Thank you all.

My BCBS refused to pay any of my blood work. I was referred by my doctor to go to a specialist to get blood work done, over 6 months ago. Now I got this bill in the mail from Quest and found my EOB. They coded it 002 as “we do not cover experimental or investigational procedures” Ok…isn’t the entire point of blood work to investigate? Anyway, should I call my insurance or the specialist to appeal the bill? Any advice? This has never happened to me before. Thank you!

I just had my first mammogram (just turned 40). My breast are extremely dense. Otherwise, normal/negative mammogram. I did the ABUS and now they want me to come back for additional ultrasound due to artifact versus true mass. At this point, I don’t really trust the ultrasound because of how dense my breasts are. The ultrasound lady kinda laughed at how white the screen was after she did the imaging. So here is my question: has anyone with extremely dense breasts ever gotten a screening mri of breast covered for extremely dense breasts? Not really counting on being able to do it as a screening test at this point because I’m probably now only able to diagnostic tests due to the ABUS findings. Asking for future testing mostly. I called BCBS and they were useless. I asked “if I have extremely dense breasts and my doctor puts that as the ICD:10 for a screening mri of breast will it be covered?” It lists screening mri of breasts as covered on my EOB. The lady on the phone couldn’t answer me. Appreciate any insight. Thank you!

Location: Michigan At a loss here. Just received a statement from my health care provider that BCBS denied my iron infusion from January and that I owe $11,000. I had iron deficient anemia during my pregnancy and iron pills didn’t do anything to raise my levels so my doctor ordered iron infusions. I didn’t think anything of it as during my first pregnancy in 2023, I also had iron deficient anemia and my iron infusions were covered by my insurance but it was through a different health care provider. BCBS is claiming that the treatment I received for iron deficient anemia isn’t covered. The procedure was coded as q0138. Do I appeal? Do I call my health care provider and see if they coded this wrong? Owing $11k for something that’s been covered before is stressing me out. I never would have agreed to iron infusions if I had known it would be denied. I cannot afford an $11k bill…