ComplaintsforBaton Rouge General Medical Center

• Initial Complaint

  05/30/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I don't know who's responsible, so I'm creating two complaints for each of the Provider, Baton Rouge General and Blue Cross Blue Shield, and I've worked with both. This is complaint 1 of 2 and they are identical. The health provider has sent 2 revisions to their order for accidental injury office visit I made in 8/2022. At first, they considered/coded it as an "Ocrruence Code" = 11, which means it's a simple onset of injuries. This was later, to my knowledge, revised to an ocurrence code = 01 indicating the accident component of the injury. Blue Cross has since reprocessed my claim twice more and I am still being charged as if this claim is due to Onset of Injury/Illness and is requiring that I pay the amount of 241 dollars that is not covered by my deductible. Earlier 5/25/23, I was notified that Blue Cross had been in contact with BR General and was explained by them that since my claim on 8/29/2022 was due to a fall, that that was why the coverage was different than an injury/claim made on 2/5/2023. However, this is incorrect. Accidental injury, by definition in the Benefit Plan FEP Blue Focus, page 81, "What is an accidental injury? An accidental injury is an injury caused by an external force or element such as a blow or fall and which requires immediate medical attention, including animal bites, and poisonings. (See Section 5(g) for dental care for accidental injury.) ". According to my incident, and the coverage offered, I sustained an injury due to a fall at 10pm on 8/27/2022. On 8/29/2022 at 9am, I visited my primary care for treatment of that injury. The timeline stated here and on the order from the provider clearly indicate this was within the 72-hour window to meet that definition of coverage. Also, according to my coverage, for accidental injury claims, "FEP Blue Focus - Preferred Nothing for outpatient, hospital and physician services within 72 hours", why am I being asked to cover the full amount of the plan allowance when this should be covered?

  Business response

  06/09/2023

  This is **** ******** PFS Supervisor responding on Kendall Johnson's behalf.

  BRG has filed Mr. ******** account 3 times to Blue Cross and they continue to apply towards his deductible.  We have contacted Blue Cross and the physician's office and will be sending in a 4th claim to Blue Cross for processing.

  If you have any questions or concerns please let us know.

  Thanks,

  **** *******

  225-819-1020

• Initial Complaint

  12/14/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 8/29/22, I went to BR General - Ascension to evaluate a knee injury that occurred less than 2 days prior. According to my insurance policy, this was covered under accidental injury and the office visit occurred within 72 hours of injury. The dr office sent me to x-ray within the same building. I was subsequently charged the whole amount of the x-ray. BR General states that the order was coded correctly and i didn’t reach my deductible so that’s why I’m being charged. The insurance company states that if the order was coded differently, namely that this was an accidental injury within 72 hours, my policy would cover the x-ray without needing it to meet a deductible. When I contact the dr office, they forward me to x-ray. X-ray then forwards me to billing and billing states they cannot make any changes. How am I, someone not versed in billing codes, supposed to know who to contact and why my benefits do not provide coverage for a given code or two, or three when it seems based on the language of my policy that this should have been covered. One thing worth mentioning, my wife, who is the policy holder, also went to a clinic for the same injury on the same date. She likewise did not have anything counting against her deductible but her office visit and x-ray were completely covered (minus a small copay). The insurance company reiciewed her EOB for that visit and stated because her order was coded slightly differently than mine. Ok, that’s fine, but why is there a difference?

  Business response

  12/15/2022

  The coding was amended on 12/13/22 and a corrected claim has been submitted to the patient's insurance on 12/14/22.

• Initial Complaint

  07/05/2021

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I Recently Seen a False Collection from a company I never heard of. Also I do not have a contract with this company and they do not have a license to collect in my state. I am a victim of identity theft and I write to dispute certain information in my file resulting from the crime that I recently became aware of. The item I am disputing do not relate to any transactions that I have made or authorized.

  Business response

  07/15/2021

  Business Response /* (1000, 5, 2021/07/15) */ We have contacted the complainant for additional information needed to respond to the complaint. It is unlikely we will be able to fully resolve by the deadline requested by BBB so this interim status is being provided. Identity Theft allegations need to be supported with affidavits and those required forms were shared. The complaint does not indicate what agency contacted him, but all agencies we do business with are licensed and that can be verified once we confirm it was a legitimate collection call.

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