My partner needed an MRI. My partner went to get an MRI with the expectation the copay is $50 as greatly advertised. My partner gets the MRI and is billed a $200 copay.
My partner learned that even though my partner went to an outpatient radiology center, the radiology center billed it as a hospital MRI. The bill being billed as a hospital MRI was not explained to my partner before or during the visit.
This hospital MRI has a different deductible of $200, which is hidden in the labyrinth of the Blue Shield of CA (u/BlueShieldofCA) benefits explanation.
Had my partner been adequately informed that it would be billed as a hospital MRI with a greater deductible, my partner would have found a third-party radiology center and had paid the $50 copay.
My partner reached out to Blue Shield of California and was told to appeal and reach out to the grievance department. The appeal was denied via email, however, the email received from Blue Shield of CA grievance department lacked any relevant information that the appeal included.
It has now been 5 months of reaching out to the grievance department to discuss the situation (as advised in the email from Blue Shield of CA grievance department to further the discussion). Many voicemails have been left with no responses received (it seems as if the Blue Shield of CA is a one person grievance department).
Upon review of the Blue Shield of CA member bill of rights, this situation appears to violate point #2: “Receive information about all health services available to them, including a clear explanation of how to obtain them.”
My 1st question is: How do we proceed? My partner has said multiple times that my partner would pay the $50 copay and ask what kind of billing will happen prior to procedures in the future.
My 2nd question is: Who else has had this happened to them? It feels like there’s got to be many individuals who end up with this surprise.
submitted by /u/SweatinPeace33
[link] [comments]My partner needed an MRI. My partner went to get an MRI with the expectation the copay is $50 as greatly advertised. My partner gets the MRI and is billed a $200 copay. My partner learned that even though my partner went to an outpatient radiology center, the radiology center billed it as a hospital MRI. The bill being billed as a hospital MRI was not explained to my partner before or during the visit. This hospital MRI has a different deductible of $200, which is hidden in the labyrinth of the Blue Shield of CA (u/BlueShieldofCA) benefits explanation. Had my partner been adequately informed that it would be billed as a hospital MRI with a greater deductible, my partner would have found a third-party radiology center and had paid the $50 copay. My partner reached out to Blue Shield of California and was told to appeal and reach out to the grievance department. The appeal was denied via email, however, the email received from Blue Shield of CA grievance department lacked any relevant information that the appeal included. It has now been 5 months of reaching out to the grievance department to discuss the situation (as advised in the email from Blue Shield of CA grievance department to further the discussion). Many voicemails have been left with no responses received (it seems as if the Blue Shield of CA is a one person grievance department). Upon review of the Blue Shield of CA member bill of rights, this situation appears to violate point #2: “Receive information about all health services available to them, including a clear explanation of how to obtain them.” My 1st question is: How do we proceed? My partner has said multiple times that my partner would pay the $50 copay and ask what kind of billing will happen prior to procedures in the future. My 2nd question is: Who else has had this happened to them? It feels like there’s got to be many individuals who end up with this surprise. submitted by /u/SweatinPeace33 [link] [comments]Read Morer/HealthInsurance