[wekebu]

Explanation of Benefits forms & participating providers

by wekebu on Wed Mar 09, 2016 2:36 pm

I'm hoping my problem is a minor one, but on every "Explanation of Benefits" form I have received from Blue Shield of California, there is an area that says "Provider: XX Hospital", then "Participating Provider: No". Every provider is notated as "No". But they are in fact participating providers.

I've called Blue Shield. They say to ignore the "No," it's a system-wide error on the Explanation Of of Benefits. These claims are being processes as participating providers.

Should I be concerned about this?

[Chris M]

Re: Explanation of Benefits forms & participating providers

by Chris M on Wed Mar 09, 2016 11:02 pm

Hi,

You wrote that the claims are being processed as participating, so I assume your EOB lists an Approved Amount, and that the total of the Blue Shield payment and your responsibility shown on the EOB equals the Approved Amount (and definitely NOT more than that). The EOB should identifiy the Discount (amount the provider must write off), which means they are a participating provider and have a contract with Blue Shield to accept that approved maximum rate.

I don't know of any other problems that could result because the EOB says "No", unless you have a secondary insurance that might depend on that for some reason when it processed the secondary claims.

Best wishes,
Chris M.

[wekebu]

Re: Explanation of Benefits forms & participating providers

by wekebu on Thu Mar 10, 2016 3:34 pm

Chris M,

Thank you for taking the time to respond. There's so much going on right now, I just wanted a second opinion.