Bcbs

[SxyPrincess]

As some of you may already know, I broke my foot last Thursday and I've been in a splint since. I visited the hospital, my PCP and and Orthopedic to get help.

Problem is--my health insurance, Blue Cross Blue Shield (HMO) won't pay for a cast or walking boot. My employer left 2 messages for our rep. to call or contact them or myself. He just called and left a message on my machine. What does he think is going to happen on a Friday afternoon?

So my question is this--is there anyone in the health care field that could give me a few suggestions as to what I should do? I'd like to sue the crap outta BCBS, that's for sure.

Maybe a nice, polite call to channel 4 news would help.

What do yall' think?

 

[vraiblonde]

HMO people should be killed

Pray they blow you off, then get a lawyer and sue the hell out of them for emotional distress. The reason they don't want to pay for anything like casts or walking shoes is because they're saving their money for the lawsuits. Get yours quick before Congress decides you can't sue negligent HMOs any more!!!

 

[RoseRed]

Wow!

I also have BC/SC Fed Emp Pgrm and have never had a problem with them. It's ridiculous that they will not pay for a cast. What happens if you injure it further because you don't have one? What then? I wish I had some advice for you. Feel better soon.

 

[Oz]

Do they give you a reason as to why they won't pay?

Just not part of the program? Part of the 80/20 split? What does your doctor say? Surely someone in your doctors office can explain or give you insight???

If you can, you should go ahead and buy whatever your doctor needs you to have, and then write letters to BC/BS (BS-how appropriate!) with copies of everything you have in your medical record about this incident, and copies of your receipts. Send the same packet to the Maryland Insurance Commissioner's office in Annapolis. (Don't forget to tell BC/BS about the copy sent to the MIC.) Send both by certified mail with a return receipt so you know when the packets are received and also you will know when to follow up.

I had an incident where I cancelled my health insurance with BC/BS to change providers, and they refused to refund my premium. I wrote them to tell them that I didn't need "double-coverage" from two insurance companies for the same period. Turns out that my policy was cancelled and premium refunded on the exact date I had originally requested. A refund check arrived a few days later. They don't want to cross the Insurance Commissioner! Exhaust this route in a reasonable manner, before worrying about a lawsuit. Why line the pockets of an attorney when all you really want is to heal your foot and get better as quickly as possible.

You mentioned going to your PCP and then to the specialist. That's the procedure I have to follow with my HMO. So, I don't know how you can do more than that, short of scheduling your broken foot with the insurance company, BEFORE you break it next time!

 

[Kizzy]

Nonarb,

Excellent answer! The insurance company hates the Insurance Commission. They are marked for each incident of complaint. I have Atena. They have been pretty good. I had issues when the company was Health Plus (Health Minus is what I called them), but they have gotten better. I had 2 surgeries this year and I had a huge beef with all the co-pays I had to pay. I had 4 appointments prior to the surgery for one and 6 for the other. So I was co-paid to death.