I have BlueCross BlueShield supplement to my medicare. My plan is a Regional PPO!


Question: I have BlueCross BlueShield supplement to my medicare. My plan is a Regional PPO.?
Recently, my chiropractor's ordered an MRI and his insurance clerk set up the appointment. I told her my plan was a networked PPO. She also had made a copy of my insurance card. The appointment was made for me at an imaging center, and I paid $100.00 co-pay. Today I received paperwork from BCBS, and it looks as if the facility was out of network and I will have to pay over $400. Isn't it the responsibility of the insurance clerk to choose an MRI facility that was in my network? The card says "Regional PPO." I had mentioned to the clerk I had a PPO plan, and I am pretty sure I told the facility when I called them. Was it my responsibility to have checked with the insurance company myself? Or should I have relied on the doctor's office to have chosen a facility within my network? There are several in my city. I learned after the fact, unfortunately. Usually, I do check myself online to see if the doctor is in my network, but this time I didn't because I thought the clerks knew what they were doing. I had discussed my plan with them. Do I have any recourse?

Answers:

you can complain. this happened to my wife for an MRI. we had to pay. it,s the individuals responsibility to find out who is covered. i would still make a fuss.



It is your responsibility to check with your Medigap plan to see if it covers that procedure. Your doctor's office never knows what each patient's plan covers from other providers. You could speak to your Medigap plan administrator and see if they will pay the charge.




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