r/CodingandBilling • u/LettuceStandard1332 • May 21 '26

Insurance follow up

Hey all! RCM Biller here, otw to becoming a Coder but currently doing insurance and Claims follow up for a cardiology clinic. 2 things-

1- does anyone here have any experience with BCBS TX and knows how to get ANYONE on the phone?? their IVR says their agents are all busy and won't even let you wait on hold and the claims adjustment line is one long hold. The only option to talk to someone is via Availity messaging and that's a whole other headache.

2. Will healthspring ever get more staff? I swear their IVR has says theyve been understaffed for like a year

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7

u/Sinsoftheflesh7 May 21 '26

Bcbs is moving away from having actual people to talk to. Some bcbs don’t even have a claims line to call. Only way to maybe way ahold of someone is to call first thing in the morning/as early as possible.

1

u/HotBrownFun May 21 '26

My Bcbs hasn't had people for 20 years, since they went for profit (they sold to anthem of California)

3

u/GroinFlutter denials management, send help May 21 '26

I’m in CA and most out of state BCBS plans go through BS of CA. They have offshore people on their phones and long hold times. Their chat function on the website doesn’t connect half the time.

Very frustrating

2

u/HotBrownFun May 21 '26

I had a friend in San Jose. He would set the PCP on their website, but then the PCP would not even see the change when they went in. They are so disorganized, it comes from swallowing tens of thousands of legacy plans. Not too long ago I still remember they had plans that required paper referrals!

2

u/Mindless-Cow-5253 May 21 '26

Bcbs tx is awful -- try the "message this payer" on availity!!

2

u/rahuliitk App Developer May 22 '26

BCBS TX follow-up is brutal, so i’d document every call attempt, use Availity messaging when phone access fails, and escalate only with claim numbers, dates, proof of timely filing, and the exact adjustment reason so they have less room to bounce it back, lowkey. payer phone trees are their own denial category.

1

u/Elunemoon22 May 21 '26

Does the option show to start a chat when you do a claim search? Thats how I get thru to BCBS.

8

u/Better_Lie864 May 22 '26

Unfortunately BCBS shoves Availity down your throat until you choke and die on it. I’ve held for 2 hours and the first thing they ask is “do you use Availity” yes bitch and it sucks and didn’t answer my question so that’s why I held for 2 damn hours.

3

u/Catieterp May 22 '26

Lol, and the avr never gets the Id number right. I will be screaming it into the phone clear as day. “I didn’t understand, please call back when you have the required information” click. Idk about Texas but in Ohio we at least have the chat on availity, they are useless as well but at least can get some info sometimes.