Insurance Saga

Well, the news is not good. Here is the response I received: Blue Cross and CHRIAS have been unable to resolve the negotiations. Therefore, CHRIAS will no longer be participating with Blue Cross as of 12/15/06. So now what?

Here is more information that I received: Since you are enrolled in the Blue Cross PPO plan, you can still go to this group as an out-of-network practice. You will be responsible for a $300 deductible. Blue Cross will pay 80% of the allowable for billed services and you will be responsible for the balance. Remember the balance will be the 20% of the allowable plus any balance over the allowable can be billed to you by the provider. I have also asked Blue Cross for a list of other providers in the network who offer this service but since you already are with this group, I don't know if you would want to go to anyone else at this point. The physician that is available in-network is Dr. Leon Katz in Upland, PA. at Crozer. I failed to add that if you have already had the surgery, any care rendered within 90 days of the surgery is covered at no additional charge by CHRIAS since those services are covered as part of the global for the surgery. Any care beyond 90 days may be rendered by the physician at Crozer. He is part of Blue Cross' network and has agreed to render care for patients of this practice.

Thank you Carla for the update. As of right now I'm covered under gobal until Nov. 28th under Chrias. I happened to call Delmarva Baratric Center to see if I could continue getting fills at there office, but was dissapointed with the answer. Their response was that they do take BCBS (POS), but since I didn't have surgery there I would have to come to one of their seminars, and pay a one time fee of $2500 whi*****ludes fills free for one year and their gym. Again Thank you for the helpful information. Jackie C

Hey Carla, Thanks for the update....Is this all Blue Cross/Blue Shield or just Blue Cross/Blue Shield of Delaware...My insurance company Blue Cross Blue Shield of Pa. had no clue what I was talking about when I asked them about the situation......Keep up the updates. Thanks again.....Good Luck

I also have BC/BS PPO and was told I would not have any problems AGAIN this morning when I called inquiring why the last few CHRIAS bills was denied. BC/BS told me that if CHRIAS would send the bills to the proper PO Box then my bills would get paid. Imagine that. LOL I can go anywhere since I am employed by one of the largest Medical Equipement company world wide. Maybe it is who the administrator of the Insurance......

I'm really surprised to hear this, especially with a PPO. I have BCBSDE with a PPO, and they paid the ENTIRETY of my DS costs. I had to go out of network - up to NYC, in fact - to get a DS, as there are no surgeons in DE that do it. If it helps you, I'd scream loud and long about that. If you can't get an RNY paid for in DE and I can get a DS in NYC paid for, then there is a HUGE problem with the way BCBSDE is being run.

I have BCBS of California PPO. I have been told by CHRIAS that if I am able to have my surgery by Dec 15th all is good. If not I will have to pay $8000 up front for my surgery then try to get reimbursed from my insurance company. I feel so defeated. I have all of my clearances and now all I can do is wait. I am on the waiting list. I feel so quilty for hoping that someone will be bumped due to not getting cleared and then I would be moved up and be able to get mine. Isn't that horrible? I started this process in July but my husband was changing jobs so everything got put on hold. As of Nov 1st I was able to start getting my clearances and move forward and now this disaster with BCBS. I just pray that everyone who needs to get the surgery by Dec 15th will be able to (including me).

Has anyone heard anymore on this insurance saga?

Hi, My name is Terry and I went through the same thing with CHRIAS. I switch to Dr. Katz and already had my consultation with him. He and his staff are wonderful. Always willing to ask questions and keep you posted as to each step of the way. I am hoping to have my surgery the first part of January. If you have any more questions, please feel free to contact me at my home e-mail - [email protected]