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File Complaint

lesa2016

I can't get my claims paid because my doctors aren't in network and there is no referral for them.  Why do I need a referral for a family practice doctor  that I've been going to for 30 years and he's the one that referred me to my neurologist.  What good is it to pay $236 a month for nothing.   

Parents
  • 0
    Hello, If you have an HMO plan you do need a referral from the Primary Care Provider (PCP) that is documented in our files. Your PCP would have to be an in-network provider under your plan and would have to be noted in our system.

    I'm happy to have my team take a look at your claims if you still have any questions. You can send us a private message with your plan ID and contact information. ~ Kayla
  • 0 in reply to BCBSTX Connect Team
    Why was that not explained when I signed up. I gave him the names of my doctors and he checked and told me they were not in network. I did call the name that has shown up as my PCP and we told I had to make an appointment and drive to Greenville just to get a signature for a referral. I've been managing my health myself, I don't need some doctor that Blue Cross picks, to be a gatekeeper. There are claims this year someone needs to look into to tell me what has to be done to get Blue Cross to except MY doctors to reimburse me for all the extra's I've had to pay. Member ID ZGN924887164 group 166913
Reply
  • 0 in reply to BCBSTX Connect Team
    Why was that not explained when I signed up. I gave him the names of my doctors and he checked and told me they were not in network. I did call the name that has shown up as my PCP and we told I had to make an appointment and drive to Greenville just to get a signature for a referral. I've been managing my health myself, I don't need some doctor that Blue Cross picks, to be a gatekeeper. There are claims this year someone needs to look into to tell me what has to be done to get Blue Cross to except MY doctors to reimburse me for all the extra's I've had to pay. Member ID ZGN924887164 group 166913
Children
  • 0 in reply to lesa2016
    Hello, I apologize if this was not made clear when you enrolled. A requirement of an HMO plan is to use an in-network PCP and obtain referrals to see any providers other than your PCP.

    Unfortunately if you visited a provider other than your PCP without a referral those claims cannot be allowed and will be denied. You do have the right to appeal the decision on these claims. The information on how to appeal is listed on the back of your explanation of benefits.

    You will need to select an in-network PCP. You can do this on your Blue Access for Members account.

    Please note, we recommend editing your comment to remember your group and member numbers to keep that information secure. ~ Kayla

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