GeoBlue (FEP-BCBS) exceeding slow paying claims 2024

[IAMHERE]

GEO-BLUE took over claims processing from GMMI the first of the year.  I've 7 Chemo bills from Bangkok Pattaya Hospital that are still pending; none have been paid. GEO-BLUE says " we are unfortunately experiencing longer than normal claims processing times. ".  Seems ludacris to me, they knew the work load from when GMMI did the processing previously before GEO-BLUE took over.

Anyone else having the same concerns with GEO-BLUE (FEP BCBS) ?

[lopburi3]

Indeed total mess - but the one large inpatient bill of over 700k  (which had to mail) was paid within the required 30 days (so guess that was a positive point) - others have not been and several rejected due they unable to read fax, misread or just incompetent.  Email system changed last December and I have not been able to use (unknown error - which they say they know have issues - just fax or mail).  Have tried every month and still fails.  

[Presnock]

I have bc/bs too and I thought that since these were regular bills based on appointments for service (chemo) that GEO-BLUE should have sent a form letter to the patient to give to the hospital which would then just bill the BC/BS.  If unscheduled visits and not a preferred privider then I could understand not having the OS processor provide such service but that is unlike the process that BCBS has done in the

past though the previous OS processor had failed to get the preferred provider to do the forward billiing to the insurer and we just paid up front.  I have numerous bills I need to forward to GEO-BCBS too so

I will get  on that soon to get my money back.  Good luck on your situation.  Thanks for alerting of the possibility of poor service.

2 hours ago, lopburi3 said:

Indeed total mess - but the one large inpatient bill of over 700k  (which had to mail) was paid within the required 30 days (so guess that was a positive point) - others have not been and several rejected due they unable to read fax, misread or just incompetent.  Email system changed last December and I have not been able to use (unknown error - which they say they know have issues - just fax or mail).  Have tried every month and still fails.  

I 

 

2 hours ago, lopburi3 said:

Indeed total mess - but the one large inpatient bill of over 700k  (which had to mail) was paid within the required 30 days (so guess that was a positive point) - others have not been and several rejected due they unable to read fax, misread or just incompetent.  Email system changed last December and I have not been able to use (unknown error - which they say they know have issues - just fax or mail).  Have tried every month and still fails.  

I myself did have problems with the wellness card of BCBS - couldn't even get drugs from the Hospital pharmacy without going through the hassles of translating even though bills were written in English as well as Thai - nothing extra but each time I used the wellness card the same crap so I told they could keep the card and I was no longer interested in using it for anything.  I stopped doing the exercise report weekly for points and tossed the card telling them it was useless for someone overseas where the pharmacies don't have the code US pharmacies have.  No biggie to me.  Good luck

[soisanuk]

Yes, they are exceedingly slow in processing claims.  My claim last January took over 2 1/2 months to process and then it took over 2 weeks from the "date paid" until the bank transfer was rec'd in my Thai bank account (normally, that took 5 days when GMMI was processing).   My current claim they rec'd on April 10 shows as still "in process" in their online tracking system.

 

[kimothai]

I have BC/BS and I never deal with mailing in claims or filing online.  I always call BC/BS prior to my appointments and get a Guarantee of Payment.  They send to Hospital and send me a copy.  I just do the co-pay which is usually 15%.  I haven't needed to use my BC/BS this year yet.  I usually schedule a physical at the end of year (100% covered in the past) so I will use BC/BS then.  My question is:  Has something changed that requires you to mail in a claim form now?  I've just been calling in advance for many years and never had a problem.  It just seems so much simpler to call in advance.  

[lopburi3]

12 minutes ago, kimothai said:

I have BC/BS and I never deal with mailing in claims or filing online.  I always call BC/BS prior to my appointments and get a Guarantee of Payment.  They send to Hospital and send me a copy.  I just do the co-pay which is usually 15%.  I haven't needed to use my BC/BS this year yet.  I usually schedule a physical at the end of year (100% covered in the past) so I will use BC/BS then.  My question is:  Has something changed that requires you to mail in a claim form now?  I've just been calling in advance for many years and never had a problem.  It just seems so much simpler to call in advance.  

Are you talking FEP or normal?  FEP is a special Federal Employee Program with non standard policy.  FEP had such a LOC system for a few months about 7 years ago when using AXA for overseas claims available for special group but hospitals (Bangkok Hospital I know) pulled out and do not believe was available when GMMI took over overseas claims.  Currently understand Bangkok Hospital accepts LOC from GeoBlue (but not sure if for anything but inpatient) and say there are along waits for approval (more than 3 weeks when asked in Feb).

Edited May 17 by lopburi3

[Srikcir]

Important to know:

Geo-Blue reviews FEP Overseas claims sent through the online FEP Overseas claim portal, email or app for approval of any payment to be made to policy holder. But it is Care First that makes the payment based on Geo-Blue's review.

Both are very accessible by phone for updates to claims and issues with processing. Being in Thailand I use Skype for the US toll-free calls.

Geo-Blue:  (800)699-4337

Care First: (888)999-9862

[lopburi3]

3 hours ago, lopburi3 said:

FEP had such a LOC system for a few months about 7 years ago

Sorry said wrong - they had an Letter of Credit for OP treatment - normally that have inpatient LOC available at some selected hospitals and may open at others on request.  

[IAMHERE]

Bangkok Hospital Pattaya did/does get GOB (Guarantee of Benefit) for my chemo appointments. BPH did fine last year with GMMI. However how can I possibly trust GeoBlue to honor a GOB? At the end of the day I'm afraid I'm the one that'll be declared persona non grata and kicked out of the country after being taken to court for nonpayment. 

Last year  the email BCBS sent us said GeoBlue was competent; seems not to be true.  BPH did fine last year with GMMI. I'm surprised BPH still takes FEPBCBS GOB. Chemo is around 300,000 baht each infusion. 

 

 

[Presnock]

4 hours ago, kimothai said:

I have BC/BS and I never deal with mailing in claims or filing online.  I always call BC/BS prior to my appointments and get a Guarantee of Payment.  They send to Hospital and send me a copy.  I just do the co-pay which is usually 15%.  I haven't needed to use my BC/BS this year yet.  I usually schedule a physical at the end of year (100% covered in the past) so I will use BC/BS then.  My question is:  Has something changed that requires you to mail in a claim form now?  I've just been calling in advance for many years and never had a problem.  It just seems so much simpler to call in advance.  

previously w/GMMI I would email them when I made an appointment and for what and they would send me the rquest for the bill to go to BCBS billing but one must insure that the hospital charges BCBS sometimes only for over night stays and out patient the patient must pay on day of svc.

[Sheryl]

4 hours ago, IAMHERE said:

Bangkok Hospital Pattaya did/does get GOB (Guarantee of Benefit) for my chemo appointments. BPH did fine last year with GMMI. However how can I possibly trust GeoBlue to honor a GOB? At the end of the day I'm afraid I'm the one that'll be declared persona non grata and kicked out of the country after being taken to court for nonpayment. 

 

 

 

 

A GOB (more often termed a GOP, Guarantee of Payment) is a contractual agreement between the insurer and the hospital.

 

As long as the hospital does not exceed the treatment and  charges approved, or treat for a condition other than that approved, there will not be any issue (though payment to the hospital may take time).   Not your liability but the insurer's.

[Presnock]

3 hours ago, Sheryl said:

 

A GOB (more often termed a GOP, Guarantee of Payment) is a contractual agreement between the insurer and the hospital.

 

As long as the hospital does not exceed the treatment and  charges approved, or treat for a condition other than that approved, there will not be any issue (though payment to the hospital may take time).   Not your liability but the insurer's.

Personally, I would contact BC/BS and info GeoBlue and advise them of the situation as they are the actual signers with GEO for proper support.  If BC/BS doesn't support you, then contact the OPM retirement of the lack of support as they are the office paying the insurance payments from your annuity.  Please continue to advise the support or lack of support so that your fellow retirees can at least have a heads up on what to expect from the insurance provider.  Good luck

[jas007]

I’ve got BC/BS through OPM and last fall I emailed them for a guarantee of benefits letter prior to an outpatient appointment at Bumrungrad. The insurance company emailed the hospital a guarantee letter and sent me a copy of the correspondence within a day or two.  I had to pay nothing at the hospital.
 

Fast forward to 2024 and I went through the same process for a different appointment.  After my 2024 email I received an automated response indicating that the case was being assigned to a claims specialist and that I should hear back with a few days. Then, nothing…. They never responded. I went to the appointment a few days later. After my appointment, I ended up just paying the bill.  It was no big amount, though, so I really didn’t want to sit there waiting for the cashier to figure things out. 
 

I’ve got another appointment coming up, and we’ll see if there’s a different result this time. I’m not holding my breath.  Fortunately, the cost is usually no big deal and I can always just submit the claims later, assuming I want to go through all the trouble. 
 

For what it’s worth, BC/BS also has a phone number listed for the overseas claims office, supposedly for people who need an immediate response.  I haven’t tried that yet. Maybe that actually works.

[tilac01]

I'm having the same issues with Geo Blue. Claims I filed for services in February are "in progress". BHP insurance department employee said they told her they are "overwhelmed".

[Lost Nomad]

I have FEP Blue Dental and will need some dental work done.  I'll probably use BIDC or BIDH if in Bangkok.  There is an option for e-filing the claims paperwork for reimbursement.  I'm not sure if Geo Blue handles the claims reimbursement processing.  Anyone have experience using FEP Blue Dental overseas?

Edited May 19 by Lost Nomad

[jas007]

Follow up:  I heard back from BC/BS.  They said they would be contacting the provider with a Guarantee of Benefits letter, but so far, they haven’t done it. I went to the hospital today for an appointment and the hospital had nothing.  I ended up paying the 4000 baht bill. Maybe the insurance carrier will get their act together soon, as I’ll be needing surgery in a few weeks. 

[tilac01]

It might help if you ask Geo Blue to send you a copy of the Guarantee of Benefits for your appointment via email, they're usually ok with that and send a copy in minutes.

[Sheryl]

38 minutes ago, tilac01 said:

It might help if you ask Geo Blue to send you a copy of the Guarantee of Benefits for your appointment via email, they're usually ok with that and send a copy in minutes.

As above. It may have been sent to the hospital but not to the right section/office.

 

Who at the hospital did you ask about this? Should be the 3rd party payment office. Not the cashier window. Cashiers are somettmes lazy about chasing these things down.

[soisanuk]

I received a letter dated 11 May from BCBS FEP stating:

 

Quote

Due to unexpected claims volumes, processing of the claim listed below has been delayed . . . Please allow up to fifteen (15) additional days for us to finalize the claim.

 

I expect the claims volume is normal and the cause really is either the inexperience of the GeoBlue processors, insufficient staff, or both.  If I recall correctly, GMMI had similar issues when the started. Adding to that, when they first started, BCBS FEP was performing a second review to assess their the quality of GMMI's processing of the claim before giving final approval for payment.  This may also be the case with GeoBlue.  With GMMI,  it sorted out after a while, but I don't recall the delays lasting 5 months as it now has with the change over to GeoBlue.

 

As to the guarantee letter, I request the hospital to direct bill for inpatient care only. For outpatient, I pay the  bill and file a claim for reimbursement.  This reduces my out of pocket cost as my Hospital, if they are direct billing my USA health insurance substantially increases the cost from what I incur if I "self" pay. Thus my 15% copay for outpatient care is more if I have them direct bill FEP. .

 

Edited May 24 by soisanuk

[IAMHERE]

I received the same letter for an inquiry I made. The letter dated 22nd March. I got the letter the 29th of April. Still 'Pending" as I type this comment even though the letter said it'd be 15 more days til taken care of.

[soisanuk]

I received an almost identical letter in February regarding my claim submitted in January indicating a 15 day delay. That claim was eventually approved an paid over 2 months after it was submitted.

 

 

[rumak]

The stress of having to deal with (yet another) the trevails of getting insurers to pay would have killed me long ago .  ( do they cover that ?  🙂

[IAMHERE]

Some action. Seven approval and Seven Pending.  None are available to view online, None emailed to me as EOB email. Oh, 3 are from Jan//Feb that are pending.

OK, I'll call that better but still substandard. How GeoBlue got the overseas contract for FEP-BLUE is probably amazing.

Edited June 10 by IAMHERE
Add some Sarcasm

[joealx]

On 6/10/2024 at 3:37 PM, IAMHERE said:

Some action. Seven approval and Seven Pending.  None are available to view online, None emailed to me as EOB email. Oh, 3 are from Jan//Feb that are pending.

OK, I'll call that better but still substandard. How GeoBlue got the overseas contract for FEP-BLUE is probably amazing.

Same here. I called Care First and the rep made a "case" for me. That took about a week. The problem was that they didn't pay me. they paid the hospital which I had already paid. I received a refund from the hospital.

 

In January, I needed a GOP fast for $6000, but the rep couldn't give me one because it had to be approved, so I called the GEO-BLUE headquarters in Pennsylvania and got to talk to a manager and he helped me.

[jas007]

Follow up on Geo Blue:

 

I had to fill out some forms for the hospital to request a guarantee of benefits, but once I did that, it only took GeoBlue about a week to send the Guarantee of Benefit approval to the hospital.  They’ll be paying 100% of the charges.  450,000 baht.  I’m glad I don’t have to pay that.  Anyway, the policy seems to be for 100% payment for people on Medicare who use the FEP benefits overseas where Medicare doesn’t pay.

[lopburi3]

41 minutes ago, jas007 said:

I had to fill out some forms for the hospital to request a guarantee of benefits, but once I did that, it only took GeoBlue about a week to send the Guarantee of Benefit approval to the hospital.

Are you talking as rep for FEP/Blue or actual travel insurance from GeoBlue? Under previous two overseas provider services (AXA, GMMI) paperwork seemed to have taken only hours to be approved with preferred hospitals for FEP/Blue. 

[jas007]

Actual FEP Blue.  I guess the claims are now processed by GeoBlue.

[soisanuk]

15 hours ago, jas007 said:

Follow up on Geo Blue:

 

I had to fill out some forms for the hospital to request a guarantee of benefits, but once I did that, it only took GeoBlue about a week to send the Guarantee of Benefit approval to the hospital.  They’ll be paying 100% of the charges.  450,000 baht.  I’m glad I don’t have to pay that.  Anyway, the policy seems to be for 100% payment for people on Medicare who use the FEP benefits overseas where Medicare doesn’t pay.

 

I presume this was for non emergency treatment.  

 

As for FEP covered inpatient treatment when you have medicare, yes they cover 100%.  Once you are on medicare Part A, FEP Blue offers supplemental cover paying inpatient medical costs not covered by medicare.  Since medicare generally does not cover you outside the USA, FEP Blue will cover 100%.   In my case, I opted out of Part B as I was living in Thailand and saw no reason to pay the monthly premium for Part B.  FEP Blue continued to be my primary health care insurer for outpatient care paying 85%.  If you opt out of Part B, the only change is that FEP Blue must use the medicare schedule for limitations on cost.  Considering that medical care in Thailand is considerably less than USA, limiting the cost to the medicare schedule has no adverse affects. 

[jas007]

27 minutes ago, soisanuk said:

 

I presume this was for non emergency treatment.  

 

As for FEP covered inpatient treatment when you have medicare, yes they cover 100%.  Once you are on medicare Part A, FEP Blue offers supplemental cover paying inpatient medical costs not covered by medicare.  Since medicare generally does not cover you outside the USA, FEP Blue will cover 100%.   In my case, I opted out of Part B as I was living in Thailand and saw no reason to pay the monthly premium for Part B.  FEP Blue continued to be my primary health care insurer for outpatient care paying 85%.  If you opt out of Part B, the only change is that FEP Blue must use the medicare schedule for limitations on cost.  Considering that medical care in Thailand is considerably less than USA, limiting the cost to the medicare schedule has no adverse affects. 

 I thought about dropping Medicare Part B, as that would currently save me a few hundred dollars a month.  But there’s a premium penalty to pay if I opt to resume coverage at a later date.  And for all I know, I might do just that.  

[soisanuk]

5 hours ago, jas007 said:

 I thought about dropping Medicare Part B, as that would currently save me a few hundred dollars a month.  But there’s a premium penalty to pay if I opt to resume coverage at a later date.  And for all I know, I might do just that.  

 

Yes, there is an increase. For each year you have opted out, it is 10%.   Since I opted out 15 years ago, that would mean a 150% increase in the Part B premium if I should return to USA. If I recall correctly, you can opt back in March of each year.  Since I did not pay a premium during those 15 years, it would take some time before I hit the break even point.

 

When I researched the matter at the time I made the decision to opt out, FEP Blue would still cover any USA medical costs at  85% up to the amount on medicare's fee schedule; and I would be responsible for 100% of any charges in excess of the fee schedule.   I also found that by law that if you are medicare eligible but do not have Part B, outpatient costs allowed to be charged to you cannot exceed 115% of the medicare schedule.  

 

Considering the above and that I did not intend to return to USA, I decided that opting out of Part B was the best course of action. 

Edited Saturday at 06:25 AM by soisanuk