It just never stops.
The mail yesterday brought another very unwelcome letter from Blue Cross Blue Shield of Arkansas. They have been Sandi's insurance company the last couple of years through her job at Wal-Mart. They screw-up a lot and manage to create huge problems for the doctors as well as us. Her coverage with them ended at the end of the year as she, like everyone else at Wal-Mart, was shifted over to Aetna with a higher deductible and lower coverage. One hopes they will be better as Blue Cross Blue Shield of Arkansas constantly interfered in Sandi's medial care by refusing to pay claims correctly, listing her as not having insurance because they had failed to credit her premuim payments in a timely manner, and numerous other issues. Just last month they re-figured her knee surgery bills again for the sixth time and suddenly denied services they had authorized back in in October 2011. Of course that was appealed.
I wasn't surprised when they pulled that re-figuring deal as they have been trying to get out of things since Sandi was diagnosed with cancer. They constantly pull this sort of thing on all sorts of bills--whether they are hers or on Scott as he is on her insurance---and blame new federal regulations when that isn't remotely true or something else bogus. It is what they do and are very well known for such tactics according to the medical folks we have to deal with.
So, I wasn't surprised when they denied the initial claim for Sandi's Pet Scan back in December. They always deny the pre-authorization and the initial claim as they say it isn't medically necessary. The fact that she was a cancer patient in remission and had to be checked every three months wasn't relevant. Having gone through this each and every time, putting us and the doctors through a lot of stress and paperwork, I thought I knew what game they were playing and therefore wasn't worried.
But, yesterday they reached a new height in stupidity. They have again denied the December Pet Scan saying "medical criteria" was not met. They know the Pet Scan found Sandi's cancer was back. They also know and--at this point--paid correctly the claims for the two surgeries she had in December that were attempts to get pathology samples from the mass by her heart. So, they denied the test that found her cancer and yet had no problems paying the hospital bills that were incurred trying to get pathology samples of the same cancer.
Makes as much sense to me as paying a claim for treatment of a severe sunburn and then denying the sun exists.
So, we will appeal yet again and send a copy to the doctor so that his staff can again send the paperwork documenting again what they already know. We will also forward a copy of everything to Texas Health and Human Services since, once they get their stuff together and approve us for food stamps and Medicaid, they will automatically investigate and review all her medical stuff. Like the medical folks, they are well aware of this insurance company and have had to assist us with this kind of problem before.
It is just ridiculous how Blue Cross Blue Shield of Arkansas consistently makes everything harder than it has to be......
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7 comments:
"It is just ridiculous how Blue Cross Blue Shield of Arkansas consistently makes everything harder than it has to be......"
Not really, if they succeed in discouraging some of their clients. As far as the insurance industry is concerned, one is a useful commodity as long as one pays in. When one needs a payout, one is no longer an asset but instead a liability.
I went through nonsense with my mother's HMO a couple of times during her final months when they tried to deny her coverage for necessary nursing home stays.
Next time you hear an idiot like Sarah Palin or some other politician condemn a public option or a single-payer system by talking about "death panels," remember that the panels exist. They're private insurance companies.
Well said, Barry.
Sorry to hear all that. Be strong and thorough.
Thorough I got covered, Nigel. :))
I don't like Blue cross Blue Shield for one reason. Ten years or so back when one of the textile companies went out of business, it put a thousand in our small N.C town alone out of work. BC/BS swore they would work with the people to get them affordable insurance.
My sister and her husband filled out all the papers and received a bill for five thousand dollars a month. The government was going to cover a significant portion which left them paying all but a thousand a month, which took up 90% of their combined unemployment checks.
Needless to say, they went without for a bit until they found other work.
Fortunately for me, I'd been laid off the year before and found I could no longer do the physical labor I once did(I'd office worked for fifteen years) and was encouraged to file for disability.
Good luck dealing with them. Don't give up(of course I've learned enough to know you guys aren't quitters) and keep plugging. We keep you in our thoughts.
the system is broken, Randy.
Johnny Carson used to refer to them, aptly, as Blue Shaft.
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