I now have to find another doctor, as mine is no longer part of BCBS. The receptionist told me he was dropped by them. Under what circumstances would blue cross/blue shield do this, drop a physician provider?
There are dozens of possible reasons. The most likely explanation is they couldn’t agree on a contracted rate. If you’re worried that it’s because of malpractice issues or something like that, your state licensing board will probably have a searchable database listing any professional disciplinary actions.
My first thought is that he was filing fraudulent claims. Have you looked up your doctor’s license to see if he’s ever been disciplined by your state?
As RNATB said…
It’s more likely that the doctor dropped the insurance company, because he was unhappy with their reimbursement rates.
I thought that too. The receptionist said he was dropped, but my best guess is the other way around. Or perhaps because they could not agree on the rate, which is pretty much the same thing. Anyway, great doctor without any taint.
BCBS sucks (my health plan uses them). We have had more than one doctor end their BCBS contracts because of unreasonable administrative overhead placed onto the doctors’ staffs. BCBS rejects, contests, delays, or generally makes processing difficult enough that too many hours were being spent compared to other insurers.
My own hearsay through the doctor grapevine, dropping BCBS is indicative of being a quality doctor, and BCBS network doctors are increasingly seen as being more bargain-basement alternatives.
Yeah, IME, it generally is the doc dropping the carrier for low reimbursement rates. But it’s a lot easier on the staff to phrase it the other way around.
My doc won’t take the lowest tier BCBS available at work. Fortunately, he takes the next one up. They didn’t fib about it though, when my employer switched to BCBS a few years ago. They just flat-out said they wouldn’t take the HMO plan because it didn’t pay well enough.
BCBS is a group of affiliated insurers, not one big company. What’s true of BCBS in your state is not necessarily or even probably true of BCBS elsewhere.
It could be a mutual inability to come to an agreement on rates. The hospital that I work for has had this happen with two different, major insurers twice in the last decade or so. They managed to finally settle their contracts some time later, but I know it’s a pain in the meantime. (IIRC, one of those incidents resulted in the hospital having to change insurers for its own employees as well.)
Health Insurance company worker here, I can confirm the most likely is they couldn’t agree on a contract, second, far more remote possibility is being dropped for fraud or other issues. And yes, Blue Cross is implementing tiered networks, for both group and individual products (and a lot of providers are electing to have a tiered benefit, this is, generally speaking, replacing managed care as a way to attempt to control costs.
Thirty-nine different companies to be precise; some serving a single state, other’s cover multiple states or only part of a single state. Some are for-profit, but most are non-profit. Collectively they insure 1 in 3 Americans.