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People complain about Medicare billing but really they should be complaining about Blue Cross Blue S1hield!  It’s an absolute sh!t-show (pardon my ‘French’).

Blue Card plans are notoriously complicated nationally, and create a huge headache for our providers.

Here’s the gist:

Where Do I File If They Aren’t In My State

Short answer:  you file to your local Blue Card brand’s claims department within your state.

Long answer:  You file locally, but if Blue Cross and Blue Shield are separate brands, then you need to inquire about where to file, either the Blue Cross brand or the Blue Shield brand.

Longer answer:  Even with that being said, if there are separate brands of Blue Cross (Anthem) and Blue Shield (Regence), there may still be a mental health carve out policy, such as Blue Shield MHSA in California.

So again, always ask where to file out of state Blue Card claims when you verify eligibility and benefits.  If you need help with this, we offer it for free within our mental health billing service.

Understanding Divided Brands

In many states, but not all states, Blue Cross and Blue Shield are two separate insurance brands.  If you’re in Texas or Illinois, for example, you will just file to BCBSTX or BCBSIL.

If you’re in CA, WA, NY, and many other states, however, you’ll need to verify exactly which brands covers this out of state policy.

Understanding Carve Outs

Many Blue Card plans are also ‘carved out’ or delegated to a different insurance company all together.

So while the card may say Blue Shield of California, it might be the case that their mental health benefits are covered by Magellan, which in California is known as Blue Shield MHSA.  This is just one example among many possible carve out issues.

(Yes, it’s a freaking nightmare!).

We Have To Say It One More Time!

Always call to verify eligibility and benefits, ask if you are in-network, and gather the insurance company claims department address on your call.  Do this for every patient to prevent huge headaches down the line.

Mission critical!!!!

If you need help with sorting out all of this BS, shoot us an email, we’re happy to help.