I currently hold Anthem Blue Cross of California insurance. If I go to their website as either a patient or a provider to try and find their claims documentation and policies it tells me the information is for California.
If I click choose state (again as a provider or patient portal) it gives a list of states. None of which I live in and says at the bottom “If your state isn’t listed, check out bcbs.com to find coverage in your area.” This directs me to my local BCBS provider where I can find the documentation for Medical Policies & Clinical UM Guidelines. These guidelines differ from those of Anthem of CA or Anthem itself (who is not the local provider).
Every EOB says that My claim was submitted to a local BCBS agency and the back of my card says providers should submit claims to the local insurance.
Does this mean that my claims and coverage are governed by the local BCBS agency or Anthem of CA? It seems like Anthem of CA may just be used as a proxy to keep my entire company under one healthcare provider.
The reason I ask this is I’m seeing differences between Anthem’s, Anthem of CA’s, and Local BCBS’s coverage for some testing. I’m trying to determine what criteria need to be met so I can hopefully get the claim approved as fast as possible.
If anyone could share insight on who’s policies actually apply to my coverage it would really be appreciated.
submitted by /u/lesserMetric
[link] [comments]
I currently hold Anthem Blue Cross of California insurance. If I go to their website as either a patient or a provider to try and find their claims documentation and policies it tells me the information is for California. If I click choose state (again as a provider or patient portal) it gives a list of states. None of which I live in and says at the bottom “If your state isn’t listed, check out bcbs.com to find coverage in your area.” This directs me to my local BCBS provider where I can find the documentation for Medical Policies & Clinical UM Guidelines. These guidelines differ from those of Anthem of CA or Anthem itself (who is not the local provider). Every EOB says that My claim was submitted to a local BCBS agency and the back of my card says providers should submit claims to the local insurance. Does this mean that my claims and coverage are governed by the local BCBS agency or Anthem of CA? It seems like Anthem of CA may just be used as a proxy to keep my entire company under one healthcare provider. The reason I ask this is I’m seeing differences between Anthem’s, Anthem of CA’s, and Local BCBS’s coverage for some testing. I’m trying to determine what criteria need to be met so I can hopefully get the claim approved as fast as possible. If anyone could share insight on who’s policies actually apply to my coverage it would really be appreciated.
submitted by /u/lesserMetric [link] [comments]Read Morer/HealthInsurance