Complaint Review: Blue Cross Blue Shield of North Carolina

In 1998 I was diagnosed with carpel tunnel syndrome in both wrists.

The condition wasn't sever enough to justify surgery, but I couldn't continue in my curent occupation so I made a career change.

That worked until 2011 when the pain became a constant.

Since I had heard good things about the Brown Hand Center, I made inquires with them and was advised they did not work with insurance companies. My primary care doctor advised me that since the Brown procedure was a patented procedure and was the only such center in the area many insurances treated them as if they were in network.

Just to be sure I call customer service of BCBSNC and asked how/if I had the procedures done at Brown if they would be covered and to what extent. I was told exactly the same thing. They would be recognized as in network and covered 100%. Note: I called BCBSNC not BCBS of Arizona.

Swell, procedures done, pain gone and BCBSNC initiated payment vouchers for the procedures with Brown, and I signed over the vouchers to Brown. Everybody's happy.

Nine months later I get two separate letters requesting a refund in the amount of $22K. Explanation, "corrected claims". I called BCBSNC to find out what "corrected claims" meant. I was told a change in criteria. That's all "a change in criteria". Now, I think this is pretty shady. They obviously already reviewed the claim and paid the claim so it must have met their criteria. I sent letters to BCBSNC, no response. Went to the Arizona Insurance Commission and was told since BCBSNC is licensed in NC, I had to go to the NC Ins Commission, which I did.

BCBSNC provided a response to the NC Ins Commission that the host company (BCBS of Arizona) processed it incorrectly. ????? I didn't call BCBS of AZ, I called BCBSNC, but guess what, they have no knowledge or record of my call. Hmm, guess that all calls are recorded for quality purposes is only for BCBS's benefit. My insurance card says BCBS of NC, not BCBS of AZ.

So, here is where it stands. I received an EOB stating the claim was paid. I received check vouchers that were signed over to the Brown Center. But, now they want their money back and are threatening collections. Oh, I did receive a "corrected" EOB where it states in small print way over to the right that the Brown Center was out of network. Got the revised EOB months after the check voucher. Where do they propose in this economy I'm going to get $22K even if I thought this was anything but shoddy business practices. Oh yea, too much time has passed so I can't appeal.

Get everything in writing up front from this company or you could wind up like me.