Delontae Pky
map-marker Providence, Rhode Island

Out-of-Network ... they really mean it

I have never been so frustrated or felt so helpless in my life!!!! I am insured through my employer in another state and therefore am constantly filing out-of-network claims. My local BCBS office that processes our claims has an internal code that is similar to the first three letters of my account ID so my claims get sent down some rat-hole and my insurer never sees the claim. I am out hundreds if not thousands in expenses that were never accounted for as deductible expenses. When I go onto my insurers website (where I'm supposed to be able to view all expenses and transactions), moving from page to page takes upwards of a minute ... insanely slow. When I try to view an itemized accounting of expenses, I have to view each family member and dependent account individually and my pharmacy charges are managed by a completely different organization and website. So, there's no way to see how my YTD deductible is computed nor account for all of my expenses. It's no wonder that our country's health care expenses are growing so fast. The organizations responsible for accounting for (and inducing) costs don't know what the *** they're doing and we (and our doctors) can't do anything about it. Is there anyone in BCBS actually managing the so called network or is it just agency vs. agency? This is insane!!!!
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if you read the back of the BCBS card it states to send it to the local office they applies there contractual rates and then fwd it to the correct office for payment.

So sending it to state they are in is correct.


First off it sounds like the local provider is sending the claim to the wrong BCBS office. It sounds like they're sending it the BCBS of the state the provider is in, and not BCBS of the state you're insured in.

Thus it's not being processed correctly. Make sure the provider knows that they need to send it to BCBS of the state you're insured by. Secondly drug benefits don't count in anyway towards medical plan deductible/out of pocket maximums. Even if one company manages both for you they're separate plans.

As for not being able to access information on all family members under one account, this is not something they can change. Legally by law each family member must be given their own account because of federal privacy law. Even a child is legally entitled to privacy of their records from their parents in general.

Now there's one other suggestion for when you get coverage out of state.

If there's no in-network providers for a good distance you can ask if they would pay the doctor you see while out of state as in-network.

This is most commonly done for college students out of state, but if you're regularly out of state and away from any in-network providers they can do the same for you.

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map-marker Providence, Rhode Island

Disabled but refusing to lower payments

My husband became disabled in March 2011. Due to sudden lack of his income we withdrew money out of a retirement account to meet the bills. We then had to pay taxes on the money we withdrew so we filed a tax return for 2012. When we applied for reduced benefits we were refused because we showed a income from our retirement account. We filed a complaint stating we withdrew the money to pay bills for 7 months until he qualified for social security disability. Although we sent as much information as we could we were still denied lower payments for insurance.
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Sarahmarie Gco

Not sure why you'd expect otherwise. Regardless of it is from wages or retirement account it's income.

The only difference is the retirement account you didn't pay taxes on at the time you earned it as wages, deferring it to when you withdrew it.


I have never, ever heard of any insurance company lowering their premiums because a person has lower income. You might have to raise the amount of your deductable in order to get lower premiums.

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