Blue Cross - Blue Shield Of North Carolina CALLING MY APPENDECTOMY MEDICALLY UNNECESSARY, REFUSING TO PAY CLAIM! Durham North Carolina
In August of 2006 I found myself suffering from intense abdominal pains that did not subside within 24 hours of onset. I contacted my doctor in Ahwatukee (Phoenix, AZ) and after being examined I was told to go to the hospital immediately -- the pains were accompanied by a 102 degree fever.
I received the best care possible from Chandler Hospital and after several tests were administered my appendix was removed later that evening. I had a smooth recovery - physically.
About one month later I started receiving bills for approximately $36K from Chandler Hospital. Surely, this had to be a mistake -- after all, my husband and I had Blue Cross/ Blue Shield of North Carolina insurance (we used to live in Virginia before the USAirways merger) -- I contacted the hospital and asked that they not send me any more bills -- and for 6 months they didn't.
June 2007 I started getting phone calls from the anaesthesiologist's billing department wanting approximately $700. I explained to them that my husband and I paid our emergency room fee and copay and that that should have been the end of it. So, at this point I've got bills coming from 2 sources because BC/BS denied the claim. Why? Chandler Hospital didn't obtain the necessary pre-surgery authorization.
Apparently, because my surgery took place late a night, it was too late on the East Coast for anyone to answer the phone and give the hospital authorization to perform my surgery. This happens all the time. Infact, if you call Blue Cross/ Blue Shield and get their recorded message they mention that "in life threatening emergencies pre-authorization is not required" Oh, really?
Perhaps we should have waited until the next morning giving my appendix time to rupture (possibly killing me) all so Chandler Hospital could do everything by the book and make the folks at Blue Cross happy.
At the hospital's urging I sent a written appeal to Blue Cross's Appeals Department and to their President and CEO. Within 2 weeks I received a letter from Kristie White in Appeals stating that Blue Cross/ Blue Shield stood firm by its decision to deny the claim as my appeal came too late --after the 180 days. I didn't start receiving phone calls until June 2007 -- that was well beyond the 180 day threshold.
Now it is October 2007 -- my surgery was more than a year ago -- I am getting bills in excess of $36,000 and threatening pre-collection notices all because Blue Cross/ Blue Shield refuses to pay a claim for a medically necessary operation.
Upon receipt of Ms. White's letter I called her and asked that she send me written documentation that I am not financially liable for the charges -- not only did she not return my call, she has yet to send me anything in the mail.
More on this later.
Steel magnolia
Phoenix, Arizona
U.S.A.
6 Updates & Rebuttals
Steel magnolia
Phoenix,Arizona,
U.S.A.
Letter to President = Problem Solved!
#7Author of original report
Wed, January 23, 2008
Nearing the end of October 2007 I received a phone call from the BC/BS of North Carolina's admin. After over a year of the hospital vs. insurance blame game BC/ BS decided to do the right thing and pay my claim. Of course, they acted like they were doing me a favor, but I am very happy that this has been resolved. This turned my $36K bill into a $500 bill.
As for the jerk who posted the rebuttal -- the insurance accused the hospital of going about things the wrong way -- not me. If the United States healthcare system wasn't flawed Michael Moore wouldn't have made the movie "Sicko".
Tom
Olathe,Kansas,
U.S.A.
Question
#7Consumer Suggestion
Sun, October 14, 2007
I'll try to offer some suggestions here in follow up postings but have some questions also, depending on how this first one is answered:
1. When did you first receive an EOB (Explanation of Benefits) from BC/BS? Typically you should have received one within 1 or 2 billing cycles, 30-60 days, after the hospital submitted a claim. The EOB would detail the charges submitted by the hospital and codes for denial. Did you get one of these at all? Even though you told the hospital not to contact you about the charges this would not have kept BC/BS sending you an EOB.
If you did receive an EOB like this then BC/BS may be saying that since you didn't appeal the denial within 180 days that the case is closed. It's going to make it more difficult to fight this if so.
Let us know.
Tom
Olathe,Kansas,
U.S.A.
Question
#7Consumer Suggestion
Sun, October 14, 2007
I'll try to offer some suggestions here in follow up postings but have some questions also, depending on how this first one is answered:
1. When did you first receive an EOB (Explanation of Benefits) from BC/BS? Typically you should have received one within 1 or 2 billing cycles, 30-60 days, after the hospital submitted a claim. The EOB would detail the charges submitted by the hospital and codes for denial. Did you get one of these at all? Even though you told the hospital not to contact you about the charges this would not have kept BC/BS sending you an EOB.
If you did receive an EOB like this then BC/BS may be saying that since you didn't appeal the denial within 180 days that the case is closed. It's going to make it more difficult to fight this if so.
Let us know.
Tom
Olathe,Kansas,
U.S.A.
Question
#7Consumer Suggestion
Sun, October 14, 2007
I'll try to offer some suggestions here in follow up postings but have some questions also, depending on how this first one is answered:
1. When did you first receive an EOB (Explanation of Benefits) from BC/BS? Typically you should have received one within 1 or 2 billing cycles, 30-60 days, after the hospital submitted a claim. The EOB would detail the charges submitted by the hospital and codes for denial. Did you get one of these at all? Even though you told the hospital not to contact you about the charges this would not have kept BC/BS sending you an EOB.
If you did receive an EOB like this then BC/BS may be saying that since you didn't appeal the denial within 180 days that the case is closed. It's going to make it more difficult to fight this if so.
Let us know.
Tom
Olathe,Kansas,
U.S.A.
Question
#7Consumer Suggestion
Sun, October 14, 2007
I'll try to offer some suggestions here in follow up postings but have some questions also, depending on how this first one is answered:
1. When did you first receive an EOB (Explanation of Benefits) from BC/BS? Typically you should have received one within 1 or 2 billing cycles, 30-60 days, after the hospital submitted a claim. The EOB would detail the charges submitted by the hospital and codes for denial. Did you get one of these at all? Even though you told the hospital not to contact you about the charges this would not have kept BC/BS sending you an EOB.
If you did receive an EOB like this then BC/BS may be saying that since you didn't appeal the denial within 180 days that the case is closed. It's going to make it more difficult to fight this if so.
Let us know.
Tallulah-phoebe
Beverly Hills,California,
U.S.A.
Sorry, but NO RIP OFF here
#7Consumer Comment
Sun, October 14, 2007
With ANY insurance provider, you MUST get pre-approval before having a surgery. And yes, there are people available 24/7 to answer the phone, as in the case of emergency surgeries. Just assuming that it is too late to call the east coast is a ridiculuous assumption on your part. It sounds like you are trying to use that as an excuse to get out of paying the bill. Insurance companies have rules for EVERYONE to follow, and no, you are not exempt from the rules.