So Has anyone Had Issues with "surprise" Billing in January

Jan 22, 2016

  1. cadylou

    cadylou Guru

    Likes Received:
    I've had a few errors that were HUGE - one client got hit with a $3300 charge from BCBS. Marketplace shows information exactly as we'd put in with proper payment amount. BCBS looks into their systems & says it has to be an error. When they talked to the Marketplace, turns out the datafile transmitted to carrier had an incorrect birth year - they made my client 10 years older . . . . .

    No way that we made an error doing the app, since all of the information was saved (application, eligibility letter, etc) and those docs show correct information. Marketplace had to "do a new application" to correct it - so I'm assuming I'm no longer the AOR.

    I had another one hit with a 2158.00 charge. He'd had an old ratesaver plan with BCBS - chose a new subsidized BCBS plan. When we checked the discrepancy - can't find one of course.

    When he got marketplace on phone with BCBS billing, they said the datafile showed him as a "female" and that because of the gender difference, BCBS tried to go in & get rate differential for the old Ratesaver plan!

    Marketplace has to re-send application data-file to BCBS to correct gender, so again - I'm probably not going to be AOR on that one either. . . . .

    (of course, had he applied for a subsidy and plan with a different carrier, BCBS would not have been able to "true it up" due to gender - but that's another issue entirely . . . .:swoon:

    What a nightmare! Clients are wondering if may have been breached since all of our documentation shows that these problems didn't exist when we did the initial applications.

    Anyone else seeing issues like this?
    cadylou, Jan 22, 2016