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Wiki BCBSIL Self Payor

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agwashburn

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Fort Drum, NY
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Has anyone had issues with BCBSIL, Self-Payor Insurance, not paying claims, saying they need medical records for almost half of the claims, even with a pre-approved authorizations? I submitted an appeal about the Administrative Simplification Rule, but they seemed to ignore it. They are also denying for multiple reasons so they don't have to pay. First they deny for timely, I proved that wrong, so then they denied for needing the medical record. I did put in a complaint to DOL EBSA, but they said the patient needs to file the complaint. It seems to be an ongoing trend with BCBSIL and it's getting very frustrating. Any ideas?
 
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