Anthem vs. MMC

I have a question for anyone who has had surgery in Portland. I have Anthem BCBS through the State of Maine as my husband is an employee of the state. The insurance covers bariatric surgery and support at 100% -- not even a co-pay for any of it. In theory, anyway. What keeps happening is that MMC bills for the nutritionist using just the facility name and not a provider name. Anthem, when I call, tells me it is covered 100%, but they need to submit the bill with a provider name. I contact MMC and they say we don't do it that way, it is the facility.

Today I got a little nasty and said it made sense to me that MMC should add the provider name if they want to be paid. I will not pay for it when it is covered 100% and they just don't bill in a way that Anthem accepts. Every time I call Anthem, I am assured everything is covered. Every time I call MMC, they fight me about billing it properly. It takes about 7 months for them to get paid for each service. It is ridiculous!

As anyone had any luck getting MMC to just bill properly from the start? I asked to have my account flagged because I am tired of having to tell MMC 10x that they have to add a provider name. I refuse to pay just because they won't bill correctly.

I havent had any problems with them yet.  The only thing I have had to pay was like $19 for one visit and I have had several.  I have the same insurance through the university system. 

MaineGal will be able to help you with this question...

I am a state employee as well..I downloaded anthems information about coverage and wanted to ask you if your husband had to wait 6 months?  I did not see anything referring to a 6 month wait etc..How was the process for him??



Terry

Hi Terry,

My husband is the state employee, but I am the one who had the surgery. There is NOT a 6-month weight with the state's Anthem's plan, and it is covered 100% . . . the wait is really going through the process with the surgery program. It took me 7 months to get my surgery from when I started the process. They hope it will take 6 so you have time to get to support groups and such. I also delayed myself a little bit because I started my appointments in July, but instead of returning to the dietician in August, I put it off until September because I have kids and wasn't sure how to manage the appointments. I saw Dr. Wolff in October and my surgery was set for 12 weeks later -- probably in part because of the holidays in the middle. I was told the wait would be 6-8 weeks, so I was pretty bummed when I was told 12 . . . but it was probably easier to do it after the holidays anyway.

Bec

Hi Bec,


Thank you for the information.


Terry