We are experiencing problems with the new Texas employee and retiree plan called HealthSelect. We participate with this pan through the BCBS Blue Essentials network. For "high-tech" imaging (CT/MR/PET) there is a $100 copay and a 80/20 coinsurance. When auditing payments we have found that for every claim a $100 copay has been applied to our payment (in many cases eliminating any payment by BCBS). We are a hospital based radiology group and only bill the professional component (modifier 26). Our billing is faster than the hospitals billing and BCBS is applying the copay to the first claim to hit the approved exam. In most of these cases the hospital would have had the opportunity to collect this $100 copay at the time of service, but not the radiology group.
We have contacted our representative at BCBS and he stated that there is no wording in our contract to address this issue but he did acknowledge that the copay should only be charged against the technical service. He said he would escalate this issue and see if he could get approval to have the copay only apply to the TC modifier, but his language did not sound promising.
Has anyone else experienced a similar copay issue? Do other groups delay filing in a attempt to avoid copay and deductible reductions hoping the hospital charge would get applied first? Has anyone been successful working with their hospitals to collect copay, deductible, or coinsurance money upfront from the patient for the independent radiology group?
Lastly, this same HealthSelect plan was applying a deductible to screening mammography exams. We made them aware of the error and they are reprocessing the claims.
Thanks,
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Jason Williams
Director
Bryan Radiology Associates
Bryan TX
(979) 776-8291
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