Blue Cross And Blue Shield Of Texas
Blue Cross Deny 96% of Claims on Elderly Patients, Force Doctor to Close Practice

In August 1997, I was one of 39 of the top billing doctors to Medicare placed under a 100% prepayment review that resulted in denying 96% of my claims.

My practice was 90% elderly patients. I provided free transportation and made home visits.in 1996, I was featured in USA Today newpaper as one of the few doctors doing home visits on Medicare patients.

Most of the claims were denied as not medically necessary. I sent patients to get xrays or lab or consult with specialists, they were paid.

I met with BC. We reviewed 11 claims that had previously been denied to find out why. Answer: "Progress notes not signed". I was told to sign and resubmit them. I did. They denied them again as not being medically necessary and/or no documentation received.

We applied for group number and got it. I was not on the initial application. We billed without me on the new group and they paid 98% of the claims. I was added to the group, billed claims, and 100% were denied.

I closed my practice in 2001 and filed a civil suit in 2003. Three trial dates have been cancelled because BC Motion for Summary Judgments. We are now in the appeals courts

Company: Blue Cross And Blue Shield Of Texas
Country: USA
State: Texas
City: Richardson
Address: 901 S. Central Expressway
Phone: 9727666900

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