I am a licensed acupuncturist and chiropractor. I am a Blue Shield provider. For the last two years Blue Shield has done everything possible to deny my claims for acupuncture and at times for chiropractic because of my dual license.

They claim that I'm not practicing within the scope of my license, which is inaccurate.

At times they paid for chiropractic treatment for patients that only received acupuncture. Once they noticed they had made a mistake they would ask for a refund. I would provide a refund and re-bill again. They would then deny the claim. After spending countless hours on the phone they finally informed me that I needed 2 separate taxonomy numbers, one for chiropractic and one for acupuncture. They provided me with a 2nd taxonomy number. It was only months later I was informed that I needed two different tax ID numbers, which is ridiculous because I'm running one practice. Finally, in October, they told me I needed a special pin for each license. I paid my biller to waste countless hours on the phone with them in addition to the time I spent on the phone with them. I spent money reformatting my billing forms to suit their continued unreasonable demands.

They are still denying the claims. Every phone call is demeaning, demoralizing and costly both financially and emotionally. They would invariably tell me that I'm not practicing within the scope of my license and each time they would end the conversation with a promise to escalate and resolve my issue.

I go through the same song and dance with claim supervisors, who apologize profusely every time, while doing nothing. I have spoken with provider relations and credentialing to no avail. I have left messages with provider credentialing without any glimpse of resolution. I spoke with supervisors who told me they would manually adjust the claims and asked me to call back in few weeks only to find out that my issue was not resolved as promised. I have heard every excuse in the book from Blue Shield. I was told by one of the supervisors that they have this issue with other dual licensed providers.

Why wouldn't they try and frustrate and stall me forever and keep me from being paid what is rightfully mine.  Through my husband's work I am insured by Blue Shield. Do you think that I would have insurance if they weren't paid their premiums? Have you faced difficulties with Blue Shield? I would like to know.

Sincerely, Dr. Victoria Lucas 

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