Flourish by Advaita Health
Flourish by Advaita Health explores the future of care at the intersection of clinical practice, individual flourishing, and society. Hosted by Tripp Johnson and Marcus Shumate, each episode features candid conversations with clinicians, patients, leaders, and innovators shaping behavioral health and beyond.
From the frontlines of clinical practice and medical innovation, to the science of flourishing through mindfulness, nutrition, exercise, and sleep, to the broader forces of society—healthcare policy, technology, and culture—we bring diverse perspectives into one conversation.
Our mission is to create a more connected, compassionate, and effective healthcare system, while helping people live healthier and more fulfilling lives.
Whether you’re a provider, policymaker, or someone passionate about health and well-being, the Advaita Health Podcast offers insight, inspiration, and practical wisdom for the challenges and opportunities ahead.
Flourish by Advaita Health
Inside the Provider Experience: Working with Blue Cross Blue Shield
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.
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