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BlueCross BlueShield (BCBS)
IMPORTANT - This information only pertains to those who have BCBS as a PRIMARY
insurance.
We welcome and file ALL BlueCross BlueShield PLANS THAT ARE SECONDARY INSURANCES TO MEDICARE.
Why is Fort Mill Dermatology in-network for BlueChoice
(Companion) insurance, but not BCBS?
Why isn't Fort Mill Dermatology in-network with BCBS and
will you be in the future?
What if my health insurance is with BCBS and I still
want to go to Fort Mill Dermatology for my care?
How much will it
cost? (Tip: Do you have an HSA or flex-spend account?)
I have BCBS of NC (or another state), NOT
BCBS of SC. Does that make a difference?
What if I am covered by more than one
insurance that includes a BCBS plan?
Is there anything that I can do or someone I can contact?
Please click
here for contact information of BCBS SC to voice your
opinion on this matter. Also feel free to
contact Greg Smith, the Office Manager of Fort Mill Dermatology, if you would like additional information on this
subject. Greg can be reached by calling 803-802-3376 x202.
BlueCross BlueShield of SC is a private company with
over $2.5 billion in annual revenues and over $1 billion in reserves
in 2006. Yet they pay physicians far less than government
healthcare plans for our military (Tricare) and our Medicare senior citizen
recipients as well as all other commercial insurance plans in SC and surrounding
states. Some might say that BCBS SC subscriber premiums pay for abnormally
high corporate executive compensation and cash reserves.
Why is Fort Mill
Dermatology in-network for BlueChoice (Companion) insurance, but not BCBS?
We are in-network
providers for BlueChoice of SC (also known as “Companion”). Although
BlueChoice is a wholly owned subsidiary of BCBS of SC and therefore has the BCBS
logos on the insurance cards, it operates, negotiates, and contracts separately
from BCBS.
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Why isn't Fort
Mill Dermatology in-network with BCBS and will you be in the future?
We have had many
former patients as well as those who would like to become new patients ask us
why we our physicians are no longer BCBS providers at this new location. Most
don’t understand how the BCBS system works. BCBS is an association of
independent companies. The company that is affiliated with BCBS in South
Carolina is different from the company that is affiliated with BCBS in North
Carolina. They are independently owned and operated.
Both of our
physicians, Drs. Smith and Iannini, were providers for BCBS through the NC BCBS
affiliate at their former medical offices in Charlotte, just a few miles north
of Fort Mill Dermatology. They were able to reach an acceptable agreement with
BCBS of NC regarding compensation and care. Because of our physical location,
our physicians must again enter into a contract with BCBS of SC if they wish to
remain providers for BCBS. We have attempted to negotiate in good faith with
BCBS of SC, but they continue to offer reimbursement well below the Medicare
level, which itself barely covers overhead. We are at a loss as to how
excellent care can be provided at or below our cost to operate. We have
contracted with more than 20 other insurance carriers/plans and so far BCBS SC has
been the only carrier that we cannot accept at this time.
We will continue to
work in good faith with BCBS of SC in hopes that they are willing to reimburse
fairly compared with the other insurance companies in the Fort Mill, SC area.
But for now, we will only be able to see BCBS patients out-of-network. We
welcome BCBS subscribers, but they must self-file their claims with their plan’s
BCBS company. This means that they BCBS subscriber pays for the visit and any
procedures at the time that services are rendered and then files the claim with
BCBS for reimbursement based on the out-of-network amounts and deductibles
allowed by the subscriber’s plan. See below for more details on how this
works.
Throughout 2007,
15% of our patients have been BCBS members who choose us for dermatologic care, take
advantage of our cash discount, and file their own insurance.
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What if my
health insurance is with BCBS and I still want to go to Fort Mill Dermatology
for my care?
We would be happy to see you as a patient and many of our patients are BCBS
subscribers. However, we advise that you
first check with your BCBS customer service representative to find out the
specifics of your out-of-network benefits. These will vary from plan to
plan. The number to call will be printed on the back of your health insurance
card.
How much will it cost?
If you choose to see us for your dermatologic care, you will be seen as a
"self-pay" patient and you must pay for your visit in full at the time of
service. Because you will be paying at the time of service and we won't
have the overhead of billing or dealing with an insurance company, we will give
you an average 40% discount off our normal fees. The amount charged for your visit
will vary depending on the services or procedures rendered. Please call us
if you would like a rough estimate based on the type of visit that you need.
At the end of your visit, we will give you a printed claim summary for the medical
services rendered that you may use to file with your BCBS plan for any allowed
reimbursement or application towards your deductible.
Do you have a BCBS HSA (high deductible) health insurance plan? If you
normally end up paying out of pocket due to a high deductible plan, our self-pay
fees may not be different or may even be less than what you would normally pay
for dermatology services in the Charlotte area.
Do you have a high co-pay? If your copay is $40 or more, this can be a
substantial portion of a typical office visit with us. However, we recommend
that you ask about the cost of any procedures prior to them being performed.
Do you have a flexible health spending account? Many patients who see us
out-of-network use their employer pre-tax flexible spending accounts to
reimburse them for our services. Getting quality dermatologic care is a
great way to utilize funds in these "use it or lose it" pre-tax accounts.
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I have BCBS of NC (or another state), NOT BCBS of SC. Does
that make a difference?
No. Because BCBS of SC has thus far been unreasonable in negotiating a
reasonable reimbursement, we have been forced to opt out of the entire BCBS PPO network.
Our office is located in SC so we must contract with the SC affiliate
of BCBS to remain in-network providers for the entire BCBS system.
Please see the expanded explanation above.
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What if I am covered by more
than one insurance that includes a BCBS plan?
If you have Medicare or a Medicare replacement as a primary insurance, then
we will file both and in most cases your benefits will be identical to those when seeing any
other dermatologist that participates with Medicare and BCBS.
If you are covered by two commercial insurances (for example: BCBS and
Cigna), then the non-BCBS plan must be primary. You CAN'T pick
and choose which insurance is primary or secondary. This is determined
by your plans and carriers. If you are unsure which is primary, you can call the
customer service numbers on the back of the insurance cards to find out.
If BCBS is your primary insurance, you will be responsible for charges as a
self-pay patient in our practice. The cash discount will apply if you pay
at the time of service since we don't file BCBS as a primary insurance.
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Is there anything that I can do or someone I can
contact?
If you feel
strongly about having Fort Mill Dermatology physicians as BCBS providers and
think that Drs. Smith and Iannini are an asset to your insurance plan, then
please relay your thoughts on the subject to BCBS of SC and ask them to be
reasonable. It is unfortunate that BCBS SC chooses astronomic profits over
reimbursement for quality health care... the true purpose of insurance. Please be respectful in your correspondence. If your health
insurance is provided by your employer, you may also want to talk to your
company’s benefits coordinator about finding an alternative health insurance
carrier.
Following is
contact information for BCBS of SC:
Provider Relations
BlueCross BlueShield of South Carolina
P.O. Box 100300
Columbia, SC 29202-3300
If you would prefer
to email, here are other Contacts with email addresses:
BCBS of SC Contacts and Email Addresses
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