Question
I'm trying to have a laparoscopy performed through a doctor who is out of network. My insurance company is Blue Cross Blue Shield of Illinois. I applied for in network authorization for an out of network doctor and was approved. My provider says that legally BCBS is supposed to negotiate my surgery rates with them since they approved me going out of network. The provider is in NY so the normal rates for surgery procedures is probably higher there than in IL. My provider said that BCBC does these negotiations but it's hard to find someone helpful because they have all been trained to not answer questions like mine. BCBS has been very difficult to work with and has previously lied to me about many things. They put up road blocks left and right so they don't have to pay for things that they should. So my questions is are they required to negotiate rates with my provider and is there anywhere that I can find the rules and regulations of BCBS or something similar?
Answer
Hi Ashley!
Usually out of network providers can negotiate with an insurance company but it is not required for either the provider or insurance company to do so. It would be in the best interest for both to do making it affordable for the patient.
Out of network means that the provider does not have an agreement to reduce their rates with your insurance carrier. The provider can negotiate with the insurance carrier however many will not.
Good Luck!
Tricia
