u/Degree_Kitchen

Any help appreciate. Having a really hard time with billing and Northern. I used to have Atrium and at the time they didn't have anyone doing it either. I prefer a physician who does it for chronic pain and not a medpsa. thank you!

Long story short, I have chronic migraines. Always have. I’ve been through the chain of medication. I failed enough medicines they put in a referral for me to get Botox.

I went to the providing NP and was approved for being a candidate. That visit was billed in network. I payed my copay.

Finally BCBS sends me a letter saying my Botox has been approved but the appointment procedure is denied. This kill’s me, I’ve been waiting so long.

Confused. I go round and round with insurance, billing, and the provider. My provider doing the procedure is a nurse practitioner, so my gut tells me they billed under the NP and not the physician or the facility. This is what it looks like on the denial letter. It says my NP’s name. When looking on the BCBS website, it says the facility is in network.

From my research you can bill under a provider, facility, overseeing physician (for NPs), or apparently NP if they have their own billing code? And sometimes since Botox isn’t a “standard” procedure it would not be how my initial visit was (in network).

Has anyone run into this? The dr office is getting annoyed with me but all they tell me is the auth was submitted “correctly” and bcbs says it must be resubmitted under the facility to process correctly. I have called everyone back and forth and am in tears frustrated.

Thanks for the help ahead of hand.

I shipped someone nails and they never paid me.. is there a process for this? I’ll probably never do this again because I have to assume someone will pay.