BlueCross BlueShield of NC Resources for Providers and Clients
Friday, February 12, 2016
Posted by: Kay Castillo
If you are a provider for BlueCross BlueShield of NC (BCBS), you may be aware of multiple issues regarding enrollment into the marketplace, overcharging consumers, issuing incorrect insurance cards, and more. Particularly, if you are a provider in the Charlotte or Raleigh/Durham areas (and now the Hickory area), you may have experienced issues in understanding if you are a provider in-network with Blue Value or Blue Local. NASW-NC has been taking member concerns and issues to both BCBS and the NC Department of Insurance.
Here are several ways you can help your clients and yourself as a provider:
For consumers having issues with insurance such as being charged too much, not sure if they have insurance or what plan they are enrolled in, they should contact the NC Department of Insurance at 1-855-408-1212 or click here and fill out an online form on the right hand side of the page. The online form will get forwarded to the correct person and someone will follow up shortly. The Department of Insurance can assist in getting money back on undue charges and help ensure insurance coverage. It is helpful, but not required, if consumers could take a picture of when they contacted BCBS with issues regarding insurance (for example, take a screen shot of the call date and time on the phone) or email documentation. Again, this is not required but can be helpful. Additionally, BlueConnect should be able to assist consumers with details of their plans and information on claims filed.
For providers having issues with consumers and understanding which networks you are in, notify Kathy Shortt at NC Department of Insurance via email at email@example.com. Let her know of the issue and impact your clients are having. Let her know of any communication you have had with BCBS. Providers can also use this link to fill out an online complaint form. There is also a list of contact information for insurance companies not regulated in NC.
Additionally, If you are not sure if your practice or facility is participating in either the Blue Value or Blue Local network, please check your status on the BCBS provider directory, or call the Provider Blue Line at 1-800-214-4844 to verify if you are participating or not. Document the response you get in case issues happen later with filing claims. If you are not participating in the Blue Value or Blue Local networks, it’s important that you tell your patients enrolled in either of these plans upfront before services are rendered, as it will have an adverse impact on their benefits if they receive care from providers or facilities not part of the Blue Value or Blue Local networks.