Insurance confirms provider is IN-NETWORD, but provider’s billing department says they’re OUT-OF-NETWORK

I need advice to help deal with this mess of a situation wiht claims processing.

Background: I have Blue Cross and Blue Shield of Illinois as my insurance carrier through my husband’s workplace. He works in Illinois. However, we live in Indiana and recently moved to a county that borders Illinois. We see medical providers in Indiana.

Prior to going to my new GP for an annual physical I called the office to make sure they accepted my insurance. I was advised to call my insurance and give them the NPI number they use to bill the insurance. They were confirmed as in-network by BCBS IL and through the provider finder on my BCBS account.

A few weeks later I received an email notification that I had balance due with the provider. That surprised me because it was for a physical and it shouldn’t go to my deductible. At first I thought they may have coded it incorrectly so I checked my EOB and saw that the code was for a physical, but then I noticed that it was processed as out-of-network.

I called the billing office to tell them that there was an error on my bill and that it should be processed as in-network. The billing staff couldn’t figure out what went wrong so she sent it to the office’s BCBS billing representative. When I was speaking to her, she stated that they billed correctly and it’s out-of-network.

This leads me to call my insurance and speak with them about all the confusion. Come to find out the issue has to do with being on a bordering county and the provider having contracts with both BCBS IL and Anthem Indiana. The provider’s office is billing BCBS IL and when they do that it’s processing as out-of-network. The claims specialist at BCBS IL says that they need to be filing through the local Anthem Indiana to be processed as in-network because I live in Indiana and I see providers in the state too.

I’ve relayed this info to the BCBS rep at the provider’s billing office and she still insists that they’re billing correctly. I have even gone so far as to be on a 3-way call with BCBS IL, the billing office, and myself to help fix things and they still refuse to bill any differently.

If anyone has had experience dealing with this I would appreciate any input in how to escalate it further to help resolve this matter.