Challenging the NPI Requirement of Blue Cross Blue Shield of Texas Again

Posted on March 4, 2012 by Dr. David Edward Marcinko MBA

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How Far Can They be Pushed?

By D. Kellus Pruitt DDS

Command-and-control organizations like BCBSTX find Facebook difficult to control. Even a small nidus of a complaint posted by a client named Mark about poor service can attract a huge bolus of payback by a dentist, and nobody respects anonymous gatekeepers for huge, unresponsive companies like BCBSTX anyway:

https://www.facebook.com/bluecrossblueshieldoftexas

Mark, as a dentist, I’m very familiar with BCBSTX’s inconsiderate behavior in our communities. At least the anonymous moderator invited your feedback. When I sincerely asked her on Wednesday what federal employees are told about BCBSTX’s NPI requirement, she acted as if the absurd policy hadn’t already wasted enough of my time that day when she provided me an irrelevant link to nowhere – just to get rid of me.

Secret Requirement?

I would actually love to treat federal employees who have BCBSTX insurance because they are some of the nicest people I’ve met. But, BCBSTX’s secret requirement that their clients see only dentists with arbitrary NPI identification numbers (not required by law) makes their employment benefit purchased with taxpayer money worthless if they receive treatment in my office. My office has been told that it has become impossible for paper claims to enter BCBSTX’s modern, computerized system without NPI numbers, and nothing humanly possible can be done to correct the unfortunate problem for dentists who choose not to be HIPAA covered entities.

Evasion?

The moderator’s evasion confirms that even though BCBSTX’s federal customers are led to believe that they can use their dental benefits to help pay for treatment at any licensed dentist’s office, they are not being informed of the NPI requirement, and if they pay the dental bill in full for work done by a dentist without an NPI number, BCBXTX pockets the reimbursement. It just cannot be helped. That’s technology. Tough-luck!

BCBSTX executives naturally prefer that my office manager tell their clients about the obscure restrictions of the dental plans they sell. She catches most federal employees before blocking out time in our schedule to treat them, but nevertheless, one got through on Wednesday morning. It wasted my time as well as the federal employee’s.

Congressional Action?

It’s troublesome to know that the government callously encourages such waste of small business owner’s time and money, not to mention the inconvenience to patients. I’m simply fed up with open appointments for uninformed BCBSTX clients. What’s it take to force BCBSTX to take some responsibility in the community and warn their customers about the limitations of their dental policy before they call my office? Congressional action?

Assessment

I do hope the anonymous BCBSTX employee doesn’t choose to delete this post. Since it seems obvious that their windfall profit is a powerful disincentive for BCBSTX to warn their clients about the NPI restriction any time soon, the more federal employees I can ethically warn through BCBSTX Facebook, the fewer open appointments I’ll have, and less taxpayer money will be wasted on silliness.

cc: Senator John Cornyn

Conclusion

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Filed under: Ethics, Health Insurance, Information Technology, Practice Management, Pruitt's Platform | Tagged: , , , , , , , , | 8 Comments »