WeWillBeatMS - the way I understand how BCBS works is if you are from out of state and go to Dr Sclafani (for example), your BCBS claim is handled by Empire. I say this because I have BCBS/State of Mich and the paperwork had to go through Empire BCBS of NY. If you have a little suitcase on your BCBS card, you can receive treatment anywhere in the USA but different offices/agencies handle it.
carollevin - you are a jewel and I thank you from the bottom of my heart for your kind & caring insights. I had no copay or deductible that had to be met. What I believe happened is that:
1) AAC made the wrong call when they insisted I self-pay
2) Because I had to pay up front, they charged me the discounted $10,000 price - even though I pointed out to them that they would benefit financially if they billed BCBS and I would guarantee payment if BCBS refused to pay
3) When I asked for an itemized bill to submit to BCBS, AAC showed the figures to add up to $10,000
4) BCBS never pays the full amount; therefore, they cut a check to AAC for $5300.
5) Under contract, providers have to accept the reduced amount from BCBS as payment in full
6) My suspicion is that AAC did not want to reimburse me the whole $10,000 so they kept giving me different excuses as to why they had not reimbursed me.
7) When the "horrid medical policy" came out, AAC then decided that would be the reason they would not reimburse me and told me "to fight it out with BCBS" (again, my opinion).
My last contact from AAC was an email telling me that I had to self-pay because I was unwilling to wait for pre-authorization. WRONG! I had been dealing with AAC and billing for 3 months prior to procedure. I believe this was a CYA (cover your ass) tactic.
9) BCBS gave me hope when the rep was quite outraged that they did not reimburse me as they are under contract to do so as an in-network provider (like you mentioned, carollevin).
My perception is that AAC screwed up royally. The very sad result is that I practically hero-worship Dr Sclafani and would not intentionally hurt him. Unfortunately, AAC billing made the mistake that I am not willing to pay for (literally).
And the most devastating thing of all is that the medical policy hurts hundreds of thousands of us.