Who has a contract with the federal government to review and process Medicare claims in your state?

Here in Illinois it is the Blue Cross/Blue Shield Association. I discovered this one day years ago when I was trying to help my elderly mother gets some medical claims paid that had been rejected. First I called Medicare and they told me I needed to talk to someone at Blue Cross/Blue Shield because the problem was on their end.

So I called Blue Cross/Blue Shield and was told that no it was Medicares problem. Got the typical run around. But basically is what happened was that after many calls and before I finally got this straightened out for my mother someone at either Medicare or Blue Cross let it slip out that no matter who I called they were the same.

That was an eyeopening day. Before that I had always thought Medicare was run and operated by a bunch of not for profit government workers. I was wrong. I get the feeling that a lot of other people aren't aware of this either.

Do you know which insurance company processes the Medicare claims in your state?

Don


http://www.opensecrets.org/orgs/summary.php?id=D000000109

Blue Cross/Blue Shield

Through its 45 local chapters, the Blue Cross/Blue Shield Association provides health care coverage to more than 80 million people. Blue Cross/Blue Shield also has a contract with the federal government to review and process Medicare claims. The association proved to be particularly active lobbying Congress during the health care reform debates of 2009 and 2010. It has also lobbied Congress to make it harder for the government to penalize companies if their employees defraud the Medicare program and process false claims. Local Blue Cross chapters have paid about $340 million to the federal government to settle Medicare fraud charges since 1993.

in my experience.

I know a VP there.

That is handled by "Anthem" which I think is linked into Blue Cross or Blue SHield.

They are a miserable organization to deal with.

But it works out great for them, because I imagine they get a lot of monies for this part of their operation. If they never have to pay any of it out, tjhey are all the merrier, profit-wise.