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Dispute with billing office!

Hi, my family live in California. My wife had a Blue Cross Individual plan when breast cancer was founded in September 2008. We immediately purchased another Blue Shield Group PPO plan through my employer and keep her individual plan at the same time.
Right now I received bills with total around 5K from hospital and surgery doctor offices after they billed Blue Cross as primary and took Blue Shield as secondary.
But during my call to insurance companies, I found both insurance companies indicate itself a primary in their system even I already gave insurance information to them just because neither plan has coordinate benefit. Three representatives of Blue Shield picked my call at different time told me same thing that I am entitled to bill Blue Shield all expense as primary regardless hospital had billed Blue Cross as primary and most bill had been paid by Blue Cross. They also told me that this approach may result some overpayment which should be reimbursed to patient.
But billing office from hospital and surgery doctor denied doing this because they never heard patient with two primary insurance and this practice is double billing.
I then called Blue Shield and they told me that I could claim by my self using the form they would mail me immediately. I just need fill it in and attach “Itemized Statement” which I could get from billing office and should include procedure code and diagnose code.
But billing office even denied providing this “itemized Statement” with procedure code.
I am confused! I really don’t know which way is correct.

Thanks for help!
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Avatar universal
Your employer should have some sort of contracted agent that handled the company policy.  I once had a dispute, although, entirely different from yours.  Our agent went explained the whole situation and told me what to say and argue, so I was able to settle the bill favorably.

Good luck, you're fighting the beast!
Helpful - 0
282113 tn?1388159749
Dear Jerry1997,

You might have figured out that the fact that both plans consider themselves your primary doesn’t work in your favor; it just means that they will not coordinate benefits.

In cases where a person is lucky enough to have 2 types of coverage, the best thing to do is to find out which plan covers a particular service at a higher level & use the insurance with higher coverage.

It is true that you can bill the insurance company directly, but be careful that you don't  bill both carriers for the same service because that is considered double billing & double billing can be considered insurance fraud.

It is hard to go into details without knowing more about your plans but my educated guess is that your group plan should cover your services at a higher level, so try to use your group plan.

The bottom line is when you need services, use only one of your policies & make sure the provider bills the correct carrier.


Amir Mostafaie
Helpful - 0

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