St. Clair Shores Allergist Waited Two Months for $200,000 After BCBS Specialty Mix-Up

Dr. Reina Salazar has practiced allergy medicine in Metro Detroit for 35 years. This summer, she found herself borrowing money from her brother to keep the lights on in her offices in St. Clair Shores and Clinton Township.

Salazar says Blue Cross Blue Shield of Michigan stopped paying her roughly two months ago, after a billing error in Blue Cross's system rejected more than 500 of her claims. The unpaid total, she says, adds up to more than $200,000. She hasn't drawn her own paycheck during that stretch, either.

"I should be retired, but with all of these problems I have, I'm never gonna retire," Salazar said. She was joking, mostly. She says the real reason she keeps showing up is that she likes seeing her patients, not that she can afford to stop.

About 70% of Salazar's business runs through Blue Cross Blue Shield, she says, which left her practice with little room to absorb the gap when the payments dried up. She uses a third-party billing company to handle claims, but she says neither her staff nor the billing company could reach anyone at Blue Cross by phone to find out what had gone wrong.

"I'm not looking to get rich, I just want to pay my workers," Salazar said. "You can't do that if you're not paid in a timely fashion by the insurance company."

Salazar says she ran into a similar problem with Blue Cross about two years ago. That time, she says, it took weeks just to identify the issue, and claims kept getting rejected even after the company told her it had been fixed.

This time, the trouble traces back to June, when Blue Cross received a provider profile update from an outside credentialing database. According to the company, that update accidentally changed Salazar's specialty designation in its own records. Blue Cross says it wasn't notified the designation was wrong until early August, at which point it worked with Salazar's office, credentialing teams and a delegated partner to sort out the correct specialty.

The company corrected the record on Aug. 7 and backdated it to Salazar's original effective date. But Blue Cross says her office never asked for the rejected claims to be reprocessed once the correction went through, so they sat unresolved.

Salazar disputes that the fix solved anything from her end. "It's disheartening that it takes Blue Cross Blue Shield this long to do anything," she said. "They said they were going to fix the issue Aug. 7, so why haven't we gotten paid?"

By her count, it took roughly seven weeks to correct the underlying mistake and another three weeks after that before the correction actually cleared. "So here we are at 8 to 9 weeks later, and I still haven't seen a paycheck," she said.

Salazar says she considered going to the state for help. "I'm scraping by, I'm down to the last crumb," she said.

The standoff broke after a Local 4 reporter contacted Blue Cross on Aug. 27 asking about the delay. Salazar says that was the first time anyone from the company actually got on the phone with her office. "This is the first time we've talked to a human being, there's always AI," she said. "I don't know how they can send a rejection for a patient so fast, but you can't get a hold of anybody."

A day later, on Aug. 28, Blue Cross adjusted and reprocessed the claims tied to Salazar's corrected specialty designation. In a statement, a Blue Cross Blue Shield of Michigan spokesperson said that because Salazar's office hadn't requested reprocessing once her specialty was fixed, the claims hadn't automatically gone through that step. The company said the reprocessed claims dated to the end of the affected period should now result in payment to Salazar.

Salazar hadn't received the money as of early September, though Blue Cross has told her office the payments are moving through its system. She said she is now checking claim by claim to see whether the Aug. 28 reprocessing clears the full $200,000 balance.