Blue Cross Blue Shield is claiming Im out of network, how can I challenge this denial?

Blue Cross Blue Shield is claiming Im out of network, how can I challenge this denial?

My sister and I were in a serious auto accident and were taken to Brackenridge trauma center. BCBS of Texas is claiming only the first 48 hours in the trauma center are covered. My sister was unconscious, and I was heavily medicated for the first 72 hours. What is the best way to challenge this denial?


The reason you are out of network is the hospital is not participating in the very poor reimbursement paid by BCBS. The hospital is gambling that the auto accident insurance may pay them better, You can bet their charges will be hugely over bloated. (Hospitals take monstrous discounts on their fees when they accept insurance as payment in full). If the wreck wasn't your fault, a lawyer will help straighten this out for a piece of the settlement. They can induce the hospital to take a discount. If you are still hospitalized, get out ASAP. As the previous answer as suggested, you may have to speak to a customoer service rep. Make sure you completely document every conversation and contact in writing including time date and persons name. Good luck. You can prevaail.


You will need to ask BCBS of Texas you want to appeal and find out what additional infomation they need. You will also need to contact the Brackenridge trauma center, tell them that your insurance is denying after the first 48 hours and ask them to refile with additional information that you mentioned. It may be a long drawn out process and you may not change their mind but definitely try. You can also ask your state attorney office for help if it gets really bad.



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