Blue Cross Blue Shield NC Purges Their Provider Rosters Without Informing ANYONE
I had not had a BCBSNC client in several years when I picked up one a few months ago. I have a BCBSNC Provider Number given to me by that insurer after filling out a truckload of paperwork 5+ years ago. I gave my biller the insured person's information and what got spit back out was that I was an 'out of network provider' (death curse).
So, I called them up. The client called them up. The some employee advised me that I had to fill out the reams of paperwork again. I started crying. Did she understand how much paperwork she was talking about? Why didn't the company utilize CAQH....an online data base WHOSE SOLE PURPOSE is to keep tabs on providers so that insurance companies can access information like current malpractice insurance/ current licensing information (DUH: you can go to the NC Psychology Board to see if I am 'active' or not).
As is usual with United HealthCare/ Humana---both Medicare Advantage companies so unregulated that CMS (Centers for Medicare and Medicaid Services) HUNG UP on me when I asked if I could obtain a copy of the new contract these 2 'Advantage' companies had signed with CMS in July, 2014----BCBSNC----which is the 'State Plan' for NC (teachers; state employees)----is very difficult to interface with.
So, after the crying episode and a period of recovery I resolved to start at the top end of things...that being the NC State Legislature which oversees BCBSNC in terms of the 'State Plan'----figuring it would lead me to info about the company in general. It did.
I called the general number for the NC State Legislature. That lead me to the 'librarian' for them. That lead me to a manager of the 'State Plan', Thomas Friedman at 919 420 1355. He indicated that the 'State Plan' had bee assigned 2-3 years ago the Department of the Treasury for the state of NC as things went amuck (gee: wasn't that when the Republicans took over the State Legislature). Actually, it seemed like a good idea that the 'State Plan' was not being managed in a partisan fashion and the feeling I have gotten from talking to people is that BCBSNC is so powerful that they sit in committee meetings and give the thumbs up or down to things being discussed by the state legislature.
In any case, Mr. Friedman gave me the telephone number for the overall liason who is the go-between BCBSNC and the state legislature/ Treasure Department. She is an employee of BCBSNC. Her number is: Ms. Evans: 919 608 3148.
This is what I told her: "Hi Ms. Evans. thanks for yr assistance. As I mentioned I am Marsha V. Hammond PhD, Licensed Psychologist NC # 2748. NPI is 1194700591. I am assigned a BCBSNC provider # which was given to me years ago. I can get that if you need it. As I stated, in February, 2014 I was apparently purged from the BCBSNC provider panel for no apparent reason. I have a BCBSNC client who works at the canton NC papermill with depression whom I have seen several times over the past several months. My biller submitted billing which went nowhere and after several very unhelpful conversations with BCBSNC employees they informed me that 'we thought you were out of practice' for no good reason. My address has not changed. My license and its status has always been viewable at the NC Psychology Board site. My CAQH credentialing information is current. CAQH is an online management tool that insurance companies use. BCBSNC is listed there as having access to all my professional information. I do not believe it is fair or just to require me to go thru months of waiting and dozens of pages of paperwork when I already did that years ago and I have a BCBSNC client requesting outpatient mental health services. They did NOT inform me of anything for I have reviewed my e mails back to the beginning of 2014. Besides this there is NO insurance company with whom I am familiar with that purges providers from its roster FOR ANY REASON unless the provider sends to them in writing a request to do so. Thus BCBSNC has violated an industry wide standard and I can only assume the purpose is to create a barrier to care by a well qualified practitioner. thanks for your help. Marsha V. Hammond, PhD"
Yeah: we will see where this goes. I think it will go like this: when the insured calls her number and states something like "M.......f.......... I need for my mental health services to be paid for"...upon which she will say, "What did you say?" (please see previous post for relevance)....and then she will say, "You understood me right, M.......f......... I want my outpatient mental health services to be paid for..."
Egads: these people just don't seem to respond to anything but point blank rudeness. Who has all day to dance around their faux nice statements?
So, I called them up. The client called them up. The some employee advised me that I had to fill out the reams of paperwork again. I started crying. Did she understand how much paperwork she was talking about? Why didn't the company utilize CAQH....an online data base WHOSE SOLE PURPOSE is to keep tabs on providers so that insurance companies can access information like current malpractice insurance/ current licensing information (DUH: you can go to the NC Psychology Board to see if I am 'active' or not).
As is usual with United HealthCare/ Humana---both Medicare Advantage companies so unregulated that CMS (Centers for Medicare and Medicaid Services) HUNG UP on me when I asked if I could obtain a copy of the new contract these 2 'Advantage' companies had signed with CMS in July, 2014----BCBSNC----which is the 'State Plan' for NC (teachers; state employees)----is very difficult to interface with.
So, after the crying episode and a period of recovery I resolved to start at the top end of things...that being the NC State Legislature which oversees BCBSNC in terms of the 'State Plan'----figuring it would lead me to info about the company in general. It did.
I called the general number for the NC State Legislature. That lead me to the 'librarian' for them. That lead me to a manager of the 'State Plan', Thomas Friedman at 919 420 1355. He indicated that the 'State Plan' had bee assigned 2-3 years ago the Department of the Treasury for the state of NC as things went amuck (gee: wasn't that when the Republicans took over the State Legislature). Actually, it seemed like a good idea that the 'State Plan' was not being managed in a partisan fashion and the feeling I have gotten from talking to people is that BCBSNC is so powerful that they sit in committee meetings and give the thumbs up or down to things being discussed by the state legislature.
In any case, Mr. Friedman gave me the telephone number for the overall liason who is the go-between BCBSNC and the state legislature/ Treasure Department. She is an employee of BCBSNC. Her number is: Ms. Evans: 919 608 3148.
This is what I told her: "Hi Ms. Evans. thanks for yr assistance. As I mentioned I am Marsha V. Hammond PhD, Licensed Psychologist NC # 2748. NPI is 1194700591. I am assigned a BCBSNC provider # which was given to me years ago. I can get that if you need it. As I stated, in February, 2014 I was apparently purged from the BCBSNC provider panel for no apparent reason. I have a BCBSNC client who works at the canton NC papermill with depression whom I have seen several times over the past several months. My biller submitted billing which went nowhere and after several very unhelpful conversations with BCBSNC employees they informed me that 'we thought you were out of practice' for no good reason. My address has not changed. My license and its status has always been viewable at the NC Psychology Board site. My CAQH credentialing information is current. CAQH is an online management tool that insurance companies use. BCBSNC is listed there as having access to all my professional information. I do not believe it is fair or just to require me to go thru months of waiting and dozens of pages of paperwork when I already did that years ago and I have a BCBSNC client requesting outpatient mental health services. They did NOT inform me of anything for I have reviewed my e mails back to the beginning of 2014. Besides this there is NO insurance company with whom I am familiar with that purges providers from its roster FOR ANY REASON unless the provider sends to them in writing a request to do so. Thus BCBSNC has violated an industry wide standard and I can only assume the purpose is to create a barrier to care by a well qualified practitioner. thanks for your help. Marsha V. Hammond, PhD"
Yeah: we will see where this goes. I think it will go like this: when the insured calls her number and states something like "M.......f.......... I need for my mental health services to be paid for"...upon which she will say, "What did you say?" (please see previous post for relevance)....and then she will say, "You understood me right, M.......f......... I want my outpatient mental health services to be paid for..."
Egads: these people just don't seem to respond to anything but point blank rudeness. Who has all day to dance around their faux nice statements?
posted by Marsha V. Hammond, PhD at 12:28 AM
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