Bluecross/BS "blue card" black hole trying to get home INR equipment

Help Support ValveReplacement.org:

kentuckyed

Member
Joined
Mar 7, 2015
Messages
15
Location
Louisville, KY
As I sit here and have my morning coffee and check emails I see this thread and just find it amazing that the USA medical system is as screwed up as it is. Profit motive does not equate to superior medical care. Medicare coverage being hawked in TV ads by has-been celebs - based on your ZIP CODE - is abhorrent. The fact that we have set up this kind of convoluted system to supposedly attempt to help people remain healthy, all to try to sucker you into accepting less care from your provider as an end result so the middle men can put more in their pocket just plain sucks.

At 71 y/o I'm kind of resigned to the fact that all people are not created equal, especially in the good old USA. And especially if you have to deal with the medical establishment. God help us all. Slipkid, I know this thread is very old but I sincerely hope that you finally got this sutuation resolved. I've been in similar loops in my own life and just want to go into a corner and scream loudly to vent some of the frustration.
 

sharky7

Well-known member
Joined
Mar 17, 2015
Messages
92
Location
SOUTH FLORIDA
As I sit here and have my morning coffee and check emails I see this thread and just find it amazing that the USA medical system is as screwed up as it is. Profit motive does not equate to superior medical care. Medicare coverage being hawked in TV ads by has-been celebs - based on your ZIP CODE - is abhorrent. The fact that we have set up this kind of convoluted system to supposedly attempt to help people remain healthy, all to try to sucker you into accepting less care from your provider as an end result so the middle men can put more in their pocket just plain sucks.

At 71 y/o I'm kind of resigned to the fact that all people are not created equal, especially in the good old USA. And especially if you have to deal with the medical establishment. God help us all. Slipkid, I know this thread is very old but I sincerely hope that you finally got this sutuation resolved. I've been in similar loops in my own life and just want to go into a corner and scream loudly to vent some of the frustration.
I am right behind you at in MAY/2022 going to be the big and infamous 69 y/o, and getting younger every year. retired in 2004 after 31yrs with postal service, and if THEY would have done to me what is being said here, i may have gone Postal on them!!!
I am right now, 2015 the owner of a MECH MITRAL VALVE/St Jude! and have been for about a year or so with a NEW machine from ebay/$500, and 48 strips for about $200 or so, aint too bad, and I know that I am blessed to be able to do that, I am also a Vet, so testing with the VA has been really all over the place, the home testing gives me peace of mind, and its now NOT all over the place......tad high, eat a good size salad, TOO low, take 1MG till i get it in range, and doing that does not make it take a huge jump, but goes up SLOWLY, AND i know many that read that know exactly what I mean by that!!!

THEY TELL that i need to be, 2.5-3.5, AND I do go into VA for monthly testing, 4 weeks........and this last time while on phone with VA I told em that I am and have been home testing, WOW what i surprise, i was thinking they would at some point ask me about it but they never did, I have been just about bullseye for a few months.

SO NOW WHAT do they do, they have me now on 6weeks testing......LOL! how about that?
About all of this, and am now getting to my point, yes I have one! I think with all that I have been thru, there are many out there, and YES-DOCTORS included that dont know half as much as they wish they knew, and less then that by all of the rest! FACT is about WARFARIN, etc. they just dont know, and are only taking their best guess........
also perhaps like most of medicine is doing now in the good ole US of A!!!!

AND also what I seem to have noticed, and proved to be true is, this WARFARIN gets that INR going either up or down a bit faster then they claim to know that it does, MY INR will change from almost day to day, and they claim changes in what you take at least what? 5-7days? Well my body may be not the same as anyone else's, but it aint that different, and this is I think what adds to the problem some seem to be having keeping within range!

AND THOSE insurance companies, please that would fill a few books, right now i have Florida Blue and for some reason havent even mentioned to them about paying for home testing, and perhaps I will now.
I am also on pain management, and have mentioned that, FLA/Blue said because I need THC, and fact that I have the FEP/PPO, they wont touch THC issue cause the FEDS are still claiming THC is dangerous, and is for that reason, illegal because of those idiots in D.C.!
And Slipkid??? is there in all of this time, and if ya still with us, is there any updates to your story, and/or any others that added two cents here already, and an awesome 2cents if ya all dont mind me saying! some very good stories, and awesome advice, thank you all for sharing!!!! HHO
 

slipkid

Well-known member
Joined
Jun 12, 2014
Messages
395
Location
Schwenksville, PA, USA
....
And Slipkid??? is there in all of this time, and if ya still with us, is there any updates to your story, and/or any others that added two cents here already, and an awesome 2cents if ya all dont mind me saying! some very good stories, and awesome advice, thank you all for sharing!!!! HHO
Yeah, there are updates but with the fog of years behind me not sure I will recall everything, but basically.....

(First I had to re-read what I posted all above. Hmmm. Weird but I mentioned that the surgeon was the 1st to bill me and it was them who got my deductible but for some reason now I was thinking it was the AMBULANCE who were the first bill to actually get processed, NOT the surgeon...I don't know which right now....anyways point is the hospital lied to me & screwed me over regardless but I digress)....

Lessee. INR home testing-wise that did work out thanks to an unbelievably great BC/BS rep who straightened out a bunch of messes for me that I mentioned above. She found a company that would cover me for INR home testing without the bluegap nonsense. Think they were called RCS but 4get now (and they might have changed name a couple times). But I went through absolute hell in dealing with them, their financial/billing system was completely effed up. Their monthly charges to me basically NEVER matched up with BC/BS' Explanation Of Benefit (EOB) statements which has what BC/BS were being charged by them then with me being responsible for various deductibles. Long convoluted story as to why, think I explained it in another thread at the time but can't remember. Anyways.....

For most people this (my bills not matching what BC/BS were being charged) would not even matter but for me it was a HUGE PITA because we have a healthcare rewards program through work that we participate in and by meeting certain goals (some of them meaningless and assinine) we get $$ placed into a "healthy rewards" account (HRA) with a debit card that can be used for medical related bills. The total $ of the rewards basically matched my deductible so jumping through their hoops to earn the $ was quite worth the time & trouble.

And herein lied the rub as it were. I could use the debit card to pay RCS but since their bills to me, the amounts I was paying, DID NOT MATCH what BC/BS had been charged/documented in the EOBs (unlike any other Dr or medical bill I have ever had), my payments using the HRA, would be flagged then turned down basically every month with them then emailing me demanding I contact them and fill out forms, documenting what the bills were, and match them up with the EOBs etc.

Most of the time I just called and spent like 10-15 minutes on the phone going over things with the overlords of the HRA account and they would match up my bills to EOBs based on dates even though the amounts were wrong. Which grew increasingly frustrating and difficult for me to have to waste time on every month. I complained to RCS numerous times about their incorrect billing system to no avail over and over and over again, usually dealing with clueless reps who did not even understand how their own billing system worked (which makes sense actually since their system MADE NO SENSE to begin with AND WAS WRONG).

FInally during one of the calls with RCS talking to a rep who was totally clueless I blew my top and started screaming at her, only after I caught my breath and apologized realized that she had hung up on me.

I canceled my account etc with RCS and returned their equipment. The endless hassle of trying to explain their incorrect bills was too much for me to continue with them. After canceling my account they continued to bill me anyway for all kinds of new charges. Had to waste more time over and over with them fighting bills. Can't recall all the ins/outs. Eventually got that settled.

And cannot recall the details but somehow I got turned onto to Roche instead (probably through this forum) who were great to deal with. Stayed with them but they sold off their business to a company that has changed names or hands multiple times. I continue to use them but their billing system is a mess as well but in a totally different way. They do submit charges to BC/BS and get some $$ from them but the charges leftover to me have NEVER been billed to me, going on like 2 years now (??). I had called them multiple times about this but give up. Oh and during one of the latest company changes they did not even bill BC/BS for like a year then tried to bill them and had all their charges denied on grounds that the bills took too long to be submitted.

I realize above probably makes no sense but is the best I can explain it at this point.
 

RAS

Well-known member
Joined
May 1, 2020
Messages
89
Location
Omaha, NE
. They do submit charges to BC/BS and get some $$ from them but the charges leftover to me have NEVER been billed to me, going on like 2 years now (??). I had called them multiple times about this but give up. Oh and during one of the latest company changes they did not even bill BC/BS for like a year then tried to bill them and had all their charges denied on grounds that the bills took too long to be submitted.
Similar to your experience, but not as extreme, Biotel took 6 months to send the first invoice. Once I received that, I used their online payment portal to pay it. Later when the next invoice arrived, I logged in and saw they had 3 invoices listed online although only one (the oldest) was listed on the paper invoice. So I paid that one, called them and asked if they would be sending the other invoices that are listed online. They said they would. I also asked why they were so slow at billing. They said it was because of delays in the insurance getting back to them with approval. However, I already had EOBs from insurance showing approved status.

Anyway by end of last year they caught up. My first invoice this year arrived about 4 weeks after the date of service and about 2 weeks after the insurance EOB.
 

tom in MO

Well-known member
Joined
Jan 17, 2012
Messages
1,876
Location
MO USA
I have no trouble with Blue Cross / Blue Shield when it comes to INR supplies. My cardio's nurse set me up, I didn't even have to call the insurance company. They changed providers but that went smoothly as well.
 

sharky7

Well-known member
Joined
Mar 17, 2015
Messages
92
Location
SOUTH FLORIDA
Yeah, there are updates but with the fog of years behind me not sure I will recall everything, but basically.....

(First I had to re-read what I posted all above. Hmmm. Weird but I mentioned that the surgeon was the 1st to bill me and it was them who got my deductible but for some reason now I was thinking it was the AMBULANCE who were the first bill to actually get processed, NOT the surgeon...I don't know which right now....anyways point is the hospital lied to me & screwed me over regardless but I digress)....

Lessee. INR home testing-wise that did work out thanks to an unbelievably great BC/BS rep who straightened out a bunch of messes for me that I mentioned above. She found a company that would cover me for INR home testing without the bluegap nonsense. Think they were called RCS but 4get now (and they might have changed name a couple times). But I went through absolute hell in dealing with them, their financial/billing system was completely effed up. Their monthly charges to me basically NEVER matched up with BC/BS' Explanation Of Benefit (EOB) statements which has what BC/BS were being charged by them then with me being responsible for various deductibles. Long convoluted story as to why, think I explained it in another thread at the time but can't remember. Anyways.....

For most people this (my bills not matching what BC/BS were being charged) would not even matter but for me it was a HUGE PITA because we have a healthcare rewards program through work that we participate in and by meeting certain goals (some of them meaningless and assinine) we get $$ placed into a "healthy rewards" account (HRA) with a debit card that can be used for medical related bills. The total $ of the rewards basically matched my deductible so jumping through their hoops to earn the $ was quite worth the time & trouble.

And herein lied the rub as it were. I could use the debit card to pay RCS but since their bills to me, the amounts I was paying, DID NOT MATCH what BC/BS had been charged/documented in the EOBs (unlike any other Dr or medical bill I have ever had), my payments using the HRA, would be flagged then turned down basically every month with them then emailing me demanding I contact them and fill out forms, documenting what the bills were, and match them up with the EOBs etc.

Most of the time I just called and spent like 10-15 minutes on the phone going over things with the overlords of the HRA account and they would match up my bills to EOBs based on dates even though the amounts were wrong. Which grew increasingly frustrating and difficult for me to have to waste time on every month. I complained to RCS numerous times about their incorrect billing system to no avail over and over and over again, usually dealing with clueless reps who did not even understand how their own billing system worked (which makes sense actually since their system MADE NO SENSE to begin with AND WAS WRONG).

FInally during one of the calls with RCS talking to a rep who was totally clueless I blew my top and started screaming at her, only after I caught my breath and apologized realized that she had hung up on me.

I canceled my account etc with RCS and returned their equipment. The endless hassle of trying to explain their incorrect bills was too much for me to continue with them. After canceling my account they continued to bill me anyway for all kinds of new charges. Had to waste more time over and over with them fighting bills. Can't recall all the ins/outs. Eventually got that settled.

And cannot recall the details but somehow I got turned onto to Roche instead (probably through this forum) who were great to deal with. Stayed with them but they sold off their business to a company that has changed names or hands multiple times. I continue to use them but their billing system is a mess as well but in a totally different way. They do submit charges to BC/BS and get some $$ from them but the charges leftover to me have NEVER been billed to me, going on like 2 years now (??). I had called them multiple times about this but give up. Oh and during one of the latest company changes they did not even bill BC/BS for like a year then tried to bill them and had all their charges denied on grounds that the bills took too long to be submitted.

I realize above probably makes no sense but is the best I can explain it at this point.
WOW, and i thought I was having problems with some DOCTORS offices, etc. LOL, and OMG??? what the hell is going on, i had one heart doc billing me as I got into the office for an office visit, i am going what the fk is that all about, i stopped going. what happened was, i was setup for a STRESS TEST, hehehe as we all are, right??? got to make sure the ole heart dont give out under stress, well this office was causing me....what they were doing was charging me the $30 for office visit, and i told them....wth is that about, charging me for office visit when I was coming for a hmmmmm xcuse me, STRESS TEST? and i simply asked, what was that all about, but i got a BS answer, and after that last "TEST!!!!" i just stopped going, got some bills but i ignored them.
and SLIPKID sorry to hear all about the trouble you had, and were having, there is ZERO excuse for that, NONE!!!! I even tried to inform FLA BLUE of some of the maybe over billing, and they acted like they flat out, didnt care! I mainly now deal with the VA, but am thinking of getting an outside heart doc., I think that I might do that, but not exactly why yet. right now havent seen a HEART DOC. got to be right near 2 years or so, maybe more. SO please let me get this right, the machine you have now is on lease from INSURANCE? if so, are they charging you much? if ya dont mind me asking, and your story from the get go is oh so disgusting, this crap was never suppose to happen, well not in the USA in any case, best nation in the world, sure seems that we are truly failing in a few ways, and can do much better, again, i think.
are there any others that deal with the VA, and have a machine for hometesting, either thru the VA, or if they bought it themselves, i bought mine......hmmmm after ALOT of thinking about it, but have now owned it for over a year, perhaps close to 2 years, rightly dont remember right now.
AND TOM, is your BC/BS state, or the FEP? if ya dont mind me asking, mine is FEP, i am retired USPS, 31yrs! [federal employee program] lol, well come on, some may not know, right slipkid? and SUPERMAN, and btw clark is my favorite super hero growing up!!!!!!!!
 

slipkid

Well-known member
Joined
Jun 12, 2014
Messages
395
Location
Schwenksville, PA, USA
SO please let me get this right, the machine you have now is on lease from INSURANCE?
Yes. (well not leased FROM insurance but on lease from the company providing the service, and covered by my insurance)

if so, are they charging you much?
The latest company (and I cannot even recall what they are calling themselves now since they changed to another name or company recently) bills BC/BS once in a while (the last time they billed BC/BS was Nov 2021) for $880 per month. Btw, that was a roughly $700 increase from what the previous company (RCS I think was their name) was charging most months.

BC/BS only allows them to charge a total of $11.76 though and knocks down their $880 charge to $11.76, of which depending on when I was billed (whether I've already met my deductible or not) BC/BS either pays none of that $11.76 (leaving me responsible for $11.76) or if I've already hit my deductible (like with that Nov. bill) then they pay 90% of it leaving what I owe the provider as $1.18. Well worth that expense on my part, quite a bargain in fact, since I've not been billed for anything!

That provider has yet to bill me for any of the charges I am responsible for (going back like 2 years, but that includes like a years worth of bills which BC/BS turned down because they took so long to submit the bills that the charges were denied by BC/BS and supposedly I am responsible for not one penny of those late bills).

Have no idea why they don't bill me what they are owed at this point but judging by how effed up their billing was in the first place (there is another thread about this up here somewhere, where some of us were scratching our heads because almost a year had gone by with NO BILLS AT ALL TO US OR BC/BS), OR perhaps it does not even pay them to bill me for just a couple bucks OR maybe they went out of business anyways - and are now another company also who has yet to bill me at all - or any combination of the reasons I am guessing, or they just don't want their $, I've given up. I had already called them 2-3 times over the last year or two and asked about this, i want to pay them what they are owed by me, but every time I've called they have said the same thing like "just wait until the system bills you".
 

tom in MO

Well-known member
Joined
Jan 17, 2012
Messages
1,876
Location
MO USA
WOW, and i thought I was having problems with some DOCTORS offices, etc. LOL, and OMG??? what the hell is going on, i had one heart doc billing me as I got into the office for an office visit, i am going what the fk is that all about, i stopped going. what happened was, i was setup for a STRESS TEST, hehehe as we all are, right??? got to make sure the ole heart dont give out under stress, well this office was causing me....what they were doing was charging me the $30 for office visit, and i told them....wth is that about, charging me for office visit when I was coming for a hmmmmm xcuse me, STRESS TEST? and i simply asked, what was that all about, but i got a BS answer, and after that last "TEST!!!!" i just stopped going, got some bills but i ignored them.
and SLIPKID sorry to hear all about the trouble you had, and were having, there is ZERO excuse for that, NONE!!!! I even tried to inform FLA BLUE of some of the maybe over billing, and they acted like they flat out, didnt care! I mainly now deal with the VA, but am thinking of getting an outside heart doc., I think that I might do that, but not exactly why yet. right now havent seen a HEART DOC. got to be right near 2 years or so, maybe more. SO please let me get this right, the machine you have now is on lease from INSURANCE? if so, are they charging you much? if ya dont mind me asking, and your story from the get go is oh so disgusting, this crap was never suppose to happen, well not in the USA in any case, best nation in the world, sure seems that we are truly failing in a few ways, and can do much better, again, i think.
are there any others that deal with the VA, and have a machine for hometesting, either thru the VA, or if they bought it themselves, i bought mine......hmmmm after ALOT of thinking about it, but have now owned it for over a year, perhaps close to 2 years, rightly dont remember right now.
AND TOM, is your BC/BS state, or the FEP? if ya dont mind me asking, mine is FEP, i am retired USPS, 31yrs! [federal employee program] lol, well come on, some may not know, right slipkid? and SUPERMAN, and btw clark is my favorite super hero growing up!!!!!!!!
My BC/BS is regional and through my employer.
 

RAS

Well-known member
Joined
May 1, 2020
Messages
89
Location
Omaha, NE
I've called they have said the same thing like "just wait until the system bills you".
Yeah. Don't worry about it. They're giving you a free ride for now. By the way I have Medica, which has been easy to work with and have approved claims in a reasonable time ( regardless of what Biotel told me). The initial billing delays are Biotel's issue. They are now owned by Philips, but still use the Biotel name.

(the last time they billed BC/BS was Nov 2021) for $880 per month.
The $880 is the "chargemaster" price. Similar to a list price. Nobody pays that including the insurance companies. You can ignore it. The amount that the insurance company allows (that is the price they have agreed/contracted with the provider), the amount the insurance company pays out of the allowed amount (depends on the coinsurance, deductibles, etc. of your plan), and the amount you pay are what counts.
 

carolinemc

Well-known member
Joined
May 31, 2010
Messages
1,201
Location
kansas city, mo
I have no trouble with Blue Cross / Blue Shield when it comes to INR supplies. My cardio's nurse set me up, I didn't even have to call the insurance company. They changed providers but that went smoothly as well.
That changed cause I used to have to pay co-psy for the Testing Supplies for my Diabetes. I still do through Medicare, but they are much kinder that BCBS.
 

Superman

Well-known member
Joined
Oct 2, 2009
Messages
1,554
Location
Grand Rapids, MI, USA
This Polar bear (at a Florida Zoo) got on the drink reading about how bad health insurance providers are in the USA (based on this thread) and then was suffering the next day with his head in a bucket.
That Polar Bear has some of the finest healthcare money can buy and doesn’t have to pay a dime. There is, however, the minor risk of being “put down” if it runs into a medical problem that’s too complex. Always with the trade offs.
 

Latest posts

Top