WARNING! BCBS/Blue Cross of California

[Phranp 46]

My surgery was set for June 1st. It has now been cancelled. Why? Because Blue Cross of California refuses to pay what the Surgery Center of Santa Monica asks for, so the Surgery Center flatly refused to do my surgery. I only found this out on Monday when my doc office called to tell me. Blue Cross of California pays less than a third of what the surgical center asks.

It was hard for me to phathom how they could be contracted with BC and then REFUSE to fulfill their contract.

So, if there is anyone out there that has BCBS/Blue Cross of California be absolutely sure that the surgical center will accept your insurance. I am scrambling to find another surgeon (the surgical center was the only place my doc performs his surgeries) and a new facility. I need to do it fast or I will have to pay to have my pre-op stuff done again.

Be warned!

Fran

[ParrotheadCathy 0]

Call the California insurance commissioner's office. I don't think if they are a contracted provider with BCBS that they can refuse then to provide a service because they don't like the amount that BCBS pays.

If you must change docs, etc., ASK BCBS for names of surgeons on their provider list who used surgical facilities also on their provider list.

[Phranp 46]

As soon as this is over I have every intention of calling the commissioner. I also have the BCBS side of my ins getting in contact with the Blue Cross of California to get some answers since they supposedly have been having this battle with Surgery Center of Santa Monica for 2 years. They should never have approved the facility knowing that the Center would not honor their contract.

Thanks for the advice.

[OnTheWay to Thin 0]

the doctor/surgery center is definately in breach of contract if they are a participating or contracted provider with your insurance. So you have recourse, it just sucks that it will mess up your surgery date. Good luck with finding a way around this. I agree with Parrot, ask your insurance company for a referral and then also let them know that their doctor refused you service. They need to kick them out of their program. But also do file al complaint with the insurance commissioner, this is an unethical practice.

[RestlessMonkey 7]

Good grief! You've gotten good advice; I'll just wish you luck. I hope it all falls into place for you and I hope you "get" that first place because I agree they are in breach of contract. I think they may just be trying to price-gouge. Shame on them.