- Report: #907690
Complaint Review: Blue Cross Blue Shield of North Carolina - Durham North Carolina
Reported By:
Hot under the collar in AZ. -
Sun Lakes, Arizona, United States of America
Submitted:
Updated:
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Author Confirmed
Why?
Blue Cross Blue Shield of North Carolina
PO Box 35 Durham NC Durham, 27702 North Carolina, United States of America
Phone:
1-888-722-7441
Web:
bcbsnc.com
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Blue Cross Blue Shield of North Carolina Claim Rejection Durham, North Carolina
I was diagnosed as diabetic in 2001.
At first the diet modification and oral medication was sufficient to control the blood sugar (BS) levels.
After a time, the oral medication no longer controlled the BS and I was put on oral meds and insulin.
That also helped for a while then my BS elevated and stayed that way. During this time I switched primary care physicians. No help.
I then found a primary care that specialized in diabetes. At my initial visit I was told I was a prime candidate for an insulin pump, that my information would be provided to Medtronics, the pump manufacturer, and they would work thru a contract company (Edge Park Surgical) that would work with BCBSNC to acquire the necessary approvals and supplies.
So, I get my pump and all the supplies necessary to use it mailed to me. $12K and change according to the invoice. A couple of weeks later I receive my EOB and it shows the claim paid. I don't hear a thing from the contract company. I think all is good.
Nine months later I receive a bill from the contract company for $5K, because BCBSNC subsequently reviewed the claim and rejected it for not receiving prior authorization. I go back thru my EOB and find where it was approved and find another EOB from about 45 days later that, sure enough has "claim denied" in fine print way over to the very right side of the EOB.
Although the contract company filed an appeal, and they had a letter of medical necessity from the doctor (the letter was provided to BCBSNC with the initial claim), BCBSNC refused to pay the claim.
By the way, I'm not obese or a junk food/sweet addict. My pancreas just decided to quit producing insulin.
Now I have the contract company (Edge Park Surgical) threatening me with collections if I don't pay up the $5K, and Medtronics distancing themselves to not be involved.
Interesting enough, I have two more complaints with BCBSNC that together total about $25K that I owe.
I almost am willing to go with out insurance. I'm paying for everything anyway.
BCBSNC is not the best health insurance company out there. If you have them as an insurer be sure to get everything in writing from them.
At first the diet modification and oral medication was sufficient to control the blood sugar (BS) levels.
After a time, the oral medication no longer controlled the BS and I was put on oral meds and insulin.
That also helped for a while then my BS elevated and stayed that way. During this time I switched primary care physicians. No help.
I then found a primary care that specialized in diabetes. At my initial visit I was told I was a prime candidate for an insulin pump, that my information would be provided to Medtronics, the pump manufacturer, and they would work thru a contract company (Edge Park Surgical) that would work with BCBSNC to acquire the necessary approvals and supplies.
So, I get my pump and all the supplies necessary to use it mailed to me. $12K and change according to the invoice. A couple of weeks later I receive my EOB and it shows the claim paid. I don't hear a thing from the contract company. I think all is good.
Nine months later I receive a bill from the contract company for $5K, because BCBSNC subsequently reviewed the claim and rejected it for not receiving prior authorization. I go back thru my EOB and find where it was approved and find another EOB from about 45 days later that, sure enough has "claim denied" in fine print way over to the very right side of the EOB.
Although the contract company filed an appeal, and they had a letter of medical necessity from the doctor (the letter was provided to BCBSNC with the initial claim), BCBSNC refused to pay the claim.
By the way, I'm not obese or a junk food/sweet addict. My pancreas just decided to quit producing insulin.
Now I have the contract company (Edge Park Surgical) threatening me with collections if I don't pay up the $5K, and Medtronics distancing themselves to not be involved.
Interesting enough, I have two more complaints with BCBSNC that together total about $25K that I owe.
I almost am willing to go with out insurance. I'm paying for everything anyway.
BCBSNC is not the best health insurance company out there. If you have them as an insurer be sure to get everything in writing from them.
