Reply to insurance, billing and Children's

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[quote=Anonymous]Does anyone have any tips on dealing with insurance and Children's with billing?  We've got to several outpatient appointments (genetics, developmental peds, etc) and despite getting someone to run through codes with us, calling insurance to make sure the codes are covered, invariably, insurance gets billed for multiple things and refuses to cover (a generally very expensive) one of them.  They always pay the doctor's charge, but all these secondary charges get disallowed (so we don't even get the network rate, we're responsible for full charge).  It seems to be a mix of BCBS (who I hate, we have to fight them tooth and nail on everything) and children's awful outpatient billing practices (which are already bad because we get charged our hospital coinsurance %, not our co-pay amount).  Some issue with billing from the hospital, clinic fees (which children's insists are facility fees and covered and BCBS insists are clinic fees and not), etc.  I can never get a straight answer from either, but I'm particularly ticked that no matter how many times I talk to someone at Children's I never get all the information about everything we're going to be charged for, so even if BCBS could give me a straight answer they'd honor, I wouldn't know to ask (like the clinic/facility/whatever because children's owns the building which is miles upon miles away from the hospital fee).  We have enough medical expenses as it is covering therapies and such, and I always verify we're in network and follow the rules and make the calls ahead of time and read the plan book front to back and still, every single time, we get hit with a charge (thus far ranging from $150-600+) that no one disclosed ahead of time that insurance insists they don't cover.

Help?!?  Is this standard for Children's, a routine issue?  Should we just refuse to ever be referred to someone at Children's again?  (a bit of an issue given our pediatrician is CP&A and while they bill differently, they still refer to children's almost exclusively, and then the issue of switching providers who we're supposed to see on an ongoing basis for follow up)  We've only had BCBS for a few months, and went to Children's with prior insurance, and these charges never even showed up, let alone got passed on.[/quote]

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