Blue Cross and Preferred Providers

[Ratsima]

As a retired US federal employee I have Blue Cross/Blue Shield health insurance. Since we almost never use it, I try to review with my wife what should happen if I get hit by a truck or keel over from a stroke and actually survive. In other words, where should I be taken after the emergency care is over.

In the past, Blue Cross had a policy by which inpatient care in "preferred" hospitals was billed directly to Blue Cross. Each year they would send a nice printed booklet that contained the worldwide list of overseas preferred providers.

However, they have now gone "green" and no longer print the booklet, you just look it up online.

Unfortunately, Blue Cross now contracts with a firm called AXA Assistance as their overseas medical assistance vendor. It is to a website they maintain that you are directed in order to find providers.

So, off I went to a page called Blue Card Worldwide where I asked to search for hospitals. I then selected "Thailand" from a drop-down menu and was supposed to select my "City" from another drop-down menu.

I knew there would be trouble when the first "city" listed was "Amphur Muang". Also listed as "cities" were "Muang" and "Nai Muang". Twenty-four other places were listed including Hua Hin, Sriracha and Trat. Noticeably missing is the city in which I live, Nakhon Ratchasima; even though it is ten times larger than Trat.

After selecting your city you may choose a search range of 10, 20 or 30 miles.

Needless to say, I was unable to find a provider anywhere near me, in spite of the fact that Bangkok Hospital is a Preferred Provider and has a hospital about 3K from where I live.

In other words, this newish website is a complete and total failure. Oh, well. Got that off my chest!

[lopburi3]

Actually I find it easy to use and there never have been any hospitals outside of Bangkok and other major tourist destinations available for direct payment (hospital group does not mean other members will accept). That said AXA is the processing arm and widely known here so much more selection than last year (before they took over). As for the green comment believe it is more than that as even before they were listed on website and frequently changed so the annual listing was just a guide. AXA has had issues of payment processing/translations as they learned the new system but now seem to be quite good. That said I have never tried to use direct payment yet but have seen reports of some at Bumrungrad even using for out patient visits (which is normally not allowed).

You do not have to use one of there listed hospitals except for the direct payment - they now seem to pay within about 4 week if you fax paperwork directly so perhaps make a list of the Hospitals in Bangkok for transport if required - and plan to have enough in available cash/credit to cover payment locally if required. Believe hospital/you can call and try to make directly payment to any hospital but no guarantee they can reach agreement. If you are expecting to use the local Bangkok Hospital you might want to contact them and try to get them to talk with FEP Blue/AXA about direct payment just in case.

[Ratsima]

The point I was trying to make is that the AXA website is hopeless if you're looking for a provider. All I was trying to do was show my wife know how to find out where to take me if I were unable to make the decision myself. I couldn't get that information from the website. Although the booklet may not have been up-to-date, at least it knew that Nakhon Ratchasima actually exists and that it has preferred providers.

In the last printed booklet that I have, Bangkok Hospital in Korat is shown as a "Preferred Provider", but there is no way that you could discover that using the AXA website.

Perhaps I'm the only one who thinks that the web site ought to actually work, that it ought to contain a complete list of cities or provinces and that it ought to know that Amphur Muang, Muang, Nai Muang are not actual place names.

[lopburi3]

Believe you are taking the AXA preferred provider only rather than "other providers" which is the same thing allowing direct payment if hospital allows for FEP Blue as all providers are treated as preferred. Entering Korat search I get this result but note they do not accept direct payment.

ST. MARY'S HOSPITAL

Profile

• Hospital Name: ST. MARY'S HOSPITAL
• Hospital Type: Private
• Languages for Service: English,Thai
• Direct Settlement: No

Contact

• Physical Address Info.
  • 307 Thanon Mittraphap Road,
    3000,
    Nai Muang,
    Nakhon Ratchasima,
    Thailand.
• Telephone:+66 44 261 261
• Web Address:http://www.smhkorat.com
• No of Beds: 150
• Specialty Hospital For:
• Facilities: Cardiologist, Emergency 24 Hours Department, General Surgery, Intensive Care, Maternity Nursery, Neurosurgeon, Orthopedist, Pediatrics,
• Diagnostics: CT Scan,CT Scan 24h,Laboratory,Mammography,Ultrasound,X-Ray,
• Medical Specialities: Allergy and Immunology,Cardiology,Colon and Rectal Surgery,Dentist,Dermatology,Ear. Nose. Throat - Otolaryngology,Endocrinology,Gastroenterology,General Surgery,Geriatrics,Gynecology,Hand Surgery,Hematology,Infectious Diseases,Internal Medicine,Nephrology,Neurology,Neurosurgery,Obstetrics and Gynecology,Oncology,Opthalmology/ eye doctor,Orthopedic surgery,Pathology,Pediatric Surgery,Pediatrics,Psychiatry,Pulmonology,Radiation Therapy,Radiology,Rehabilitation,Thoracic surgery,Urology,Vascular surgery,Optometry,Plastic surgery/ cosmetic surgery/ reconstructive surgery

[Thot]

The reply I got from AXA was that there are no prefered providers in Khorat. They would try to negotiate with a hospital on inpatient services.

E-mail them with your questions. They will reply.

Edited September 5, 2013 by Thot

[lopburi3]

Thanks for the further information. But preferred provider is an AXA classification (which seems to be for there direct insurance policy) and they list only a few Bangkok hospitals as preferred but many others as having a relationship and many of these others do offer direct billing. And for FEP/Blue all overseas hospitals are paid at same preferred rate and you are free to use any. As said they can try to negotiate and you can recommend that they contact a hospital if you will be using it.

[Ratsima]

Here's what the Blue Cross website (FEP Blue) website says:

We have a network of participating hospitals overseas, as well as a network of professional providers who have agreed to accept a negotiated amount as payment in full for their services.

Here's what AXA wrote to me:

Blue Cross Blue Shield has a network of “participating providers” that are contracted to accept your insurance card within the U.S. territory, we do not have such a network overseas.

Could the two statements be any more contradictory?

Here's the Blue Cross website:

http://www.fepblue.org/faqs/overseas.jsp#international-provider-network

I have been an "overseas" Blue Cross customer since 1979. Until AXA took over there was always a nice printed list which included numerous "Preferred Providers" in Thailand, including Bangkok Hospital in Korat. Before AXA, "Preferred Provider" meant a hospital with which Blue Cross had a negotiated agreement with respect to cost and the acceptance of direct billing for inpatient services.

I'm not sure what "Preferred Provider" means now.

[lopburi3]

It appears to be a designation used for AXA insurance - not FEP/Blue - just as the previous list was what the overseas payment provider had payment agreements with (FEP/Blue contracts out every two years it seems). If you select all hospitals you will find some of the non-preferred are listed as accepting direct payment so actually there are more hospitals available now than before (but not the one you wish to use). As they said there is no preferred insurance payment difference for FEP as all overseas are treated as preferred and you may be able to get an agreement on request. In the PI there has been a serious issue as very few hospitals now accept direct billing so at least we have a half full glass on that front..

[Ratsima]

I guess my point continues to be that before AXA we had a worldwide network of preferred providers, all of whom would accept direct billing. All of these providers were listed in an easy to use printed guide.

Now it's left to us to get an agreement on request?

Before AXA I was able to tell me wife exactly where to send me, knowing full well in advance what places would accept direct billing.

I fail to see how turning everything into a mystery is any sort of improvement.

[lopburi3]

I understand the confusion but I do not see the mystery - they have the available hospitals listed on a web site in real time (that old hard copy mag list you like was often wrong and they also had an online listing which was always different). You can always print them out if you want to keep a list for family use (and you can update every few months if needed). If you can not use one of the listed hospitals you should try to get your facility to talk with AXA about an agreement and in the event of going to a hospital without you can try to get an agreement even then for your case (from what I have seen posted). But there was no network of Blue Cross international providers - it was just a designation the payment firm used for those they had arranged an agreement with. For most things we pay and file claim. This takes about one month currently if you fax claim and have ACH payment to US bank account.

[Ratsima]

A couple of questions:

- Does faxing the claim have some sort of advantage over filing online? I file online (for free) and get reimbursed (via EFT) in a week or two.

- What website are you using to locate providers?

AXA told me to use this one: http://www.bluecardworldwide.com/ (If you're asked to log in, enter: RRR)

But following links from the Blue Cross website leads you here: https://webcorp.axa-assistance.com/Home.aspx#

[lopburi3]

I always go from FEP/Blue home page using overseas provider tool link which brings up this:

https://webcorp.axa-assistance.com/Home.aspx

Fax came before on-line and there have been questions about on-line use overseas as did not provide for special claim form (fax can also be used for pharmacy at different address/number) - fax is what is always listed as my option on returned paperwork and I do on-line using faxzero.com at no cost for normal 3 pages (claim form/deposit slip-cash receipt/detailed receipt). Have no idea if any advantage but if the on-line works for you should be fine - I fill out form/print/sign and then scan with the bills/deposit slip and make PDF file for fax. Simple process using printer software and likely similar to what you have to do on-line? This also provides me copies in computer. Then staple hard copies together to await processing/payment. Indeed if you get payment within a week or two it does sound faster so may give it a try.

As mentioned there have been many issues during the transition period with language translations of bills causing long delays (but other plans make you do the translations). But things seem to be getting much better in last month or two.

After viewing that first website for Blue see your concern - much less information and no option to enter a city name of your own as on the linked site from FEP/Blue. Suspect that site is for normal emergency use of Blue providers rather than the specific world wide system for FEP plan which pays everywhere.

[Ratsima]

I can't get the link you provided to work.

No matter what city I select or type in myself I get the following messages:

"No coordinates associated to the city. Please, select another city or type a location"

-or-

"No results found for 20Kms. Do you want to extend the search range for 100Kms? "

I never get any results. It seems to me that this was sort of working yesterday.

If you file online you don't need to print the forms. You just upload the completed claim form (PDF) along with scans of the bills and receipts. I do use the overseas claims form. No need to print and sign the claims form.

[lopburi3]

Indeed that data base seems to be unavailable for any location at this time - can not even find Bangkok.

[Ratsima]

Indeed that data base seems to be unavailable for any location at this time - can not even find Bangkok.

Perhaps they decided to fix it!

[lopburi3]

Likely - night time so nobody using it. Will not go into a claim I submitted last year an hour after hospital visit only to receive it back in mail a few weeks later with request to obtain correct receipt as this could not be right with a date/time before the date/time there fax was received. No idea of time difference even in an office dedicated to overseas claims. Now hold everything until the next day to send.

[tilac01]

I find that filing Blue Cross claims online to be very simple and straightforward. It seems like the claims are now being processed within two weeks if you request payment by wire to your bank. I wish you could request payment by wire for pharmacy claims.

[lopburi3]

The problem is currently they are often paying by check (at least on fax claims) even when they say by wire - my last two claims have been checks - one notated as such on statement due to third party issues but other listed as wire payment but check just received. Which means three or four weeks extra for those of us not paying for/using on-line check processing. Right now you do not know if payment will be by ACH or check.

For pharmacy if use hospital/doctor provided out patient they are paid on normal overseas claim form so normally no check deposit required.

[tilac01]

Recently they mailed checks to me instead of wiring to my bank due to "systemic" issues in their system. I hope that issue has now been sorted out.

[lopburi3]

My last check (which was processed as being wire) was received this week so apparently it has not been resolved.

[Ratsima]

I submitted an online claim with Blue Cross about the time I started this thread. Today I received both a check and an Explanation of Benefits in the mail. This in spite of the fact that I have repeatedly signed up for electronic EOBs and direct deposit of reimbursements. No explanation as to why I got a paper check.

Plus, the Explanation of Benefits is baffling. I submitted a bill from Bumrungrad which included 2500 baht in doctor fees, a 225 baht facility fee and 850 baht for medical equipment. The reimbursement is for US$40.38 in charges. It is a partial reimbursement, but doesn't seem to match up with any of the charges that I submitted. It's too little if it's for the 2500 baht and too much if it's for the 225+850 baht. Unfortunately, the EOB nowhere informs me which part of the bill this reimbursement is for.

I remain totally unimpressed by the performance of AXA.

[lopburi3]

1. It seems all overseas claims get mail copies regardless - and now there is an additional EOB form giving details of each payment on each claim sent in another mailing (different than the web site and normal hard copy EOB).

2. I am also getting a mix of checks and ACH payments - most times if check notation is made on EOB that problem still exists and trying to resolve.

3. Was there more than one doctor fee by chance? Normally a doctor would have a visit fee less than 2,500 baht and there is a $20 co-pay before the normal payment of 85% is made and you mention this is a partial payment (which I have never seen so can not guess on that).

[Ratsima]

I finally figured out that the reason I was getting paper checks instead of EFTs was because I failed to provide the bank's physical address (PO Boxes not allowed). I added the address to my latest claim and received reimbursement as a direct deposit to my US bank account.

[joealx]

The best thing to do is call up the Worldwide Assistance Center at 804 673 1678 collect through AT@T (001 999 11111).