Flourish by Advaita Health

Inside the Provider Experience: Working with Blue Cross Blue Shield

• Tripp Johnson • Season 4 • Episode 15

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In this episode, Tripp Johnson shares his experiences and frustrations as a provider dealing with Blue Cross Blue Shield (BCBS) in North Carolina, particularly regarding their insurance claims processing and payment issues. He emphasizes the importance of being an in-network provider for quality patient care but expresses concern over BCBS's recent changes and practices that have negatively affected payment for services rendered. Johnson discusses specific incidents where payments were delayed or denied, highlighting systemic issues within BCBS. He raises concerns about the potential financial instability of BCBS and its impact on the healthcare landscape in North Carolina.

Key Points

  • In-Network Advocacy: Being an in-network provider is morally and strategically beneficial, but it comes with significant administrative challenges.
  • Claims Payment Issues: Johnson details a lengthy struggle to receive payments for services provided under BCBS, including a specific incident where $150,000 was held up for over 18 months.
  • Complex Taxonomy Changes: Recent changes in BCBS's billing taxonomy created confusion and payment issues for different levels of care (Partial Hospitalization vs. Intensive Outpatient).
  • Prior Authorization Delays: There are significant delays in obtaining prior authorizations for treatments, impacting the timely care of patients with substance use disorders.
  • Potential Death Spiral: Speculation that BCBS might be facing serious financial challenges due to the loss of a large state health plan contract, leading to potentially unethical practices to conserve cash.
  • Need for Complaints: An emphasis on the importance of documenting issues and filing complaints with the Department of Labor and the Department of Insurance to seek resolution.
  • Historical Context: A reflection on BCBS's reputation in North Carolina, noting its long-standing role as a trusted insurer and expressing concern over recent changes.

About Flourish by Advaita Health

Flourish by Advaita Health explores how people, providers, and communities move from suffering to flourishing. Each episode weaves together perspectives from healthcare, wellness, and human experience — from the science of mental and physical health to the art of living well.

Advaita Health is a North Carolina–based behavioral health organization dedicated to supporting whole-person flourishing. Learn more about our work and clinical services below.