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BlueCross BlueShield (BCBS)

 

IMPORTANT - This information only pertains to those who have BCBS PPO as a PRIMARY insurance. 

 

We welcome and file ALL BlueCross BlueShield PLANS THAT ARE SECONDARY INSURANCES TO MEDICARE. We are in-network with SC BCBS MEDICARE ADVANTAGE PLANS (as of 1/1/2011).

Why is Fort Mill Dermatology in-network for BlueChoice (Companion) and BCBS SC Medicare insurance, but not the commercial BCBS PPO Plans?

 

Why isn't Fort Mill Dermatology in-network with BCBS PPO plans and will you be in the future? 

 

What if my health insurance is with BCBS and I still want to go to Fort Mill Dermatology for my care? 

 

How much will it cost? (Tip: Do you have an HSA or flex-spend account?)

 

I have BCBS of NC (or another state), NOT BCBS of SC.  Does that make a difference?

 

What if I am covered by more than one insurance that includes a BCBS plan?

 

Is there anything that I can do or someone I can contact?

Please click here for contact information of BCBS SC to voice your opinion on this matter.  Also feel free to contact Greg Smith, the Office Manager of Fort Mill Dermatology, if you would like additional information on this subject.  Greg can be reached by calling 803-802-3376 x202.

 

BlueCross BlueShield of SC is a private company with over $2.5 billion in annual revenues and over $1 billion in reserves in 2006.  Yet they pay physicians far less than government healthcare plans for our military (Tricare) and our Medicare senior citizen recipients as well as all other commercial insurance plans in SC and surrounding states. Some might say that BCBS SC subscriber premiums pay for abnormally high corporate executive compensation and reserves.

 

 

 

 


 

Why is Fort Mill Dermatology in-network for BlueChoice (Companion) insurance and BCBS SC Medicare insurance, but not the commercial BCBS PPO Plans?

 

We are in-network providers for BlueChoice of SC (also known as “Companion”).  Although BlueChoice is a wholly owned subsidiary of BCBS of SC and therefore has the BCBS logos on the insurance cards, it operates, negotiates, and contracts separately from BCBS.  Likewise, BCBS Medicare Advantage plans mirror traditional Medicare rules and not the unfair policies of the BCBS commercial PPO plans.

 

 

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Why isn't Fort Mill Dermatology in-network with BCBS and will you be in the future?

 

We have had many former patients as well as those who would like to become new patients ask us why we our physicians are no longer BCBS providers at this new location.  Most don’t understand how the BCBS system works.  BCBS is an association of independent companies. The company that is affiliated with BCBS in South Carolina is different from the company that is affiliated with BCBS in North Carolina.  They are independently owned and operated.

 

Both of our physicians, Drs. Smith and Iannini, were providers for BCBS through the NC BCBS affiliate at their former medical offices in Charlotte, just a few miles north of Fort Mill Dermatology.  They were able to reach an acceptable agreement with BCBS of NC regarding compensation and care.  Because of our physical location, our physicians must again enter into a contract with BCBS of SC if they wish to remain providers for BCBS.  We have attempted to negotiate in good faith with BCBS of SC, but they continue to offer reimbursement well below the Medicare level, which itself barely covers overhead.  We are at a loss as to how excellent care can be provided at or below our cost to operate. We have contracted with more than 20 other insurance carriers/plans and so far BCBS SC has been the only carrier that we cannot accept at this time. 

 

We will continue to work in good faith with BCBS of SC in hopes that they are willing to reimburse fairly compared with the other insurance companies in the Fort Mill, SC area. But for now, we will only be able to see BCBS patients out-of-network.  We welcome BCBS subscribers, but they must self-file their claims with their plan’s BCBS company.  This means that they BCBS subscriber pays for the visit and any procedures at the time that services are rendered and then files the claim with BCBS for reimbursement based on the out-of-network amounts and deductibles allowed by the subscriber’s plan.  See below for more details on how this works. 

 

Throughout 2007, 15% of our patients have been BCBS members who choose us for dermatologic care, take advantage of our cash discount, and file their own insurance.

 

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What if my health insurance is with BCBS and I still want to go to Fort Mill Dermatology for my care?

We would be happy to see you as a patient and many of our patients are BCBS subscribers.  However, we advise that you first check with your BCBS customer service representative to find out the specifics of your out-of-network benefits.  These will vary from plan to plan. The number to call will be printed on the back of your health insurance card.

How much will it cost?

If you choose to see us for your dermatologic care, you will be seen as a "self-pay" patient and you must pay for your visit in full at the time of service.  Because you will be paying at the time of service and we won't have the overhead of billing or dealing with an insurance company, we will give you an average 40% discount off our normal fees.  The amount charged for your visit will vary depending on the services or procedures rendered.  Please call us if you would like a rough estimate based on the type of visit that you need.

At the end of your visit, we will give you a printed claim summary for the medical services rendered that you may use to file with your BCBS plan for any allowed reimbursement or application towards your deductible.

Do you have a BCBS HSA (high deductible) health insurance plan? If you normally end up paying out of pocket due to a high deductible plan, our self-pay fees may not be different or may even be less than what you would normally pay for dermatology services in the Charlotte area.

Do you have a high co-pay? If your copay is $40 or more, this can be a substantial portion of a typical office visit with us. However, we recommend that you ask about the cost of any procedures prior to them being performed.

Do you have a flexible health spending account? Many patients who see us out-of-network use their employer pre-tax flexible spending accounts to reimburse them for our services.  Getting quality dermatologic care is a great way to utilize funds in these "use it or lose it" pre-tax accounts.

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I have BCBS of NC (or another state), NOT BCBS of SC. Does that make a difference?

No.  Because BCBS of SC has thus far been unreasonable in negotiating a reasonable reimbursement, we have been forced to opt out of the entire BCBS PPO network.  Our office is located in SC so we must contract with the SC affiliate of BCBS to remain in-network providers for the entire BCBS system.  Please see the expanded explanation above.

 

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What if I am covered by more than one insurance that includes a BCBS plan?

If you have Medicare or a Medicare replacement as a primary insurance, then we will file both and in most cases your benefits will be identical to those when seeing any other dermatologist that participates with Medicare and BCBS.

If you are covered by two commercial insurances (for example: BCBS and Cigna), then the non-BCBS plan must be primaryYou CAN'T pick and choose which insurance is primary or secondary.  This is determined by your plans and carriers. If you are unsure which is primary, you can call the customer service numbers on the back of the insurance cards to find out.  If BCBS is your primary insurance, you will be responsible for charges as a self-pay patient in our practice.  The cash discount will apply if you pay at the time of service since we don't file BCBS as a primary insurance.

 

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Is there anything that I can do or someone I can contact?

 

If you feel strongly about having Fort Mill Dermatology physicians as BCBS providers and think that Drs. Smith and Iannini are an asset to your insurance plan, then please relay your thoughts on the subject to BCBS of SC and ask them to be reasonable.  It is unfortunate that BCBS SC chooses astronomic profits over reimbursement for quality health care... the true purpose of insurance.  Please be respectful in your correspondence.   If your health insurance is provided by your employer, you may also want to talk to your company’s benefits coordinator about finding an alternative health insurance carrier. 

 

Following is contact information for BCBS of SC:

 

Provider Relations

BlueCross BlueShield of South Carolina
P.O. Box 100300
Columbia, SC 29202-3300

 

If you would prefer to email, here are other Contacts with email addresses:

BCBS of SC Contacts and Email Addresses

 

 

 

 

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