Guest guest Posted June 14, 2001 Report Share Posted June 14, 2001 Here's the article regarding the BCBS lawsuit from Business News. Cook County sues Blues for fraud CHICAGO—In what may be the first governmental lawsuit in Illinois against a health maintenance organization for fraud, Cook County State's Attorney A. Devine sued Blue Cross & Blue Shield of Illinois on Wednesday for denying coverage for a prescription headband that corrects cranial malformities in infants. The suit, filed in Cook County Circuit Court, charges that BC/BS of Illinois is violating the Illinois Consumer Fraud Act by routinely denying coverage for the Dynamic Orthotic Cranioplasty band. In one case, according to the suit, the Blues plan refused to cover the cost of the $3,000 headband by claiming first that it was " investigational, " though the device is approved by the Food and Drug Administration, and then that the band was solely for cosmetic purposes. In two other cases, the suit charges, BC/BS of Illinois claimed that the medical necessity of a DOC band had not been established, despite doctors' prescriptions. In a statement issued after filing the suit, Mr. Devine said that Illinois Blues had committed fraud by violating its own stated policies, which say it will pay for FDA-approved corrective devices. The lawsuit seeks to prohibit BC/BS of Illinois from denying coverage for prescribed DOC bands and to identify and make coverage available to all policyholders who were wrongfully denied coverage for the DOC band. The suit also calls for the insurer to pay $50,000 in civil penalties. A spokesman for BC/BS of Illinois said he still had not seen the suit and could not comment. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2001 Report Share Posted June 14, 2001 Reading this article is like music to my ears- I just love that they are getting sued- way to go whomever the parents are I am so proud of them. I will use this article in the info I send to the local papers- maybe it will help. I think I will send a thank you note to the lawyers office representing this case- I wonder if I can find them. WIll let you all know. Beck Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2001 Report Share Posted June 15, 2001 Sue, I hope this scares the other Ins. companys to automatically pay for coverage. Its a very hard decision to band your child and money should not be the major desicion for you not to do it. our Ins. United paid 100% even though we were out of network. They denied the first claim saying we were out of network, I asked who was in network and they had no answer and pre approved us. It took 7 mths for CT to get the check. Lorraine Sonntag, Boca Raton FL. > Here's the article regarding the BCBS lawsuit from Business News. > > > Cook County sues Blues for fraud > > CHICAGO—In what may be the first governmental lawsuit in Illinois > against a health maintenance organization for fraud, Cook County > State's Attorney A. Devine sued Blue Cross & Blue Shield of > Illinois on Wednesday for denying coverage for a prescription > headband that corrects cranial malformities in infants. > > The suit, filed in Cook County Circuit Court, charges that BC/BS of > Illinois is violating the Illinois Consumer Fraud Act by routinely > denying coverage for the Dynamic Orthotic Cranioplasty band. > > In one case, according to the suit, the Blues plan refused to cover > the cost of the $3,000 headband by claiming first that it > was " investigational, " though the device is approved by the Food and > Drug Administration, and then that the band was solely for cosmetic > purposes. In two other cases, the suit charges, BC/BS of Illinois > claimed that the medical necessity of a DOC band had not been > established, despite doctors' prescriptions. > > In a statement issued after filing the suit, Mr. Devine said that > Illinois Blues had committed fraud by violating its own stated > policies, which say it will pay for FDA-approved corrective devices. > > The lawsuit seeks to prohibit BC/BS of Illinois from denying coverage > for prescribed DOC bands and to identify and make coverage available > to all policyholders who were wrongfully denied coverage for the DOC > band. The suit also calls for the insurer to pay $50,000 in civil > penalties. > > A spokesman for BC/BS of Illinois said he still had not seen the suit > and could not comment. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 6, 2004 Report Share Posted October 6, 2004 Yep, and it sounds like I just got in there too because I sent him everything on Monday. > > I am a part of this and have been sending them my info. I will > keep y'all updated if you like. They still keep denying and I don't > even want to get into it because I am so angry, but if they make my > appeals run out then I plan on continuing to send them the same > package over and over again so they can lose their money on paying > the " independent Dr " (independent my butt) to review the same things > over and over. > > > > I know, not very grown-up thing to do but I proved all their > points wrong and I have been refused to right to meet with them to > show them 's Mold and how he couldn't turn his head over. Big > jerko company. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 6, 2004 Report Share Posted October 6, 2004 Go Kimmy! Way to stick to it. They really do sound unreasonable not to let you present 's mold. It's like a big bully who keeps yelling so they don't have to hear the little person prove they are wrong. Please let us know how it goes! Becky ('s mom) in Pgh, PA --- In Plagiocephaly , Kimmy Myers <merleebird@y...> wrote: > I am a part of this and have been sending them my info. I will keep y'all updated if you like. They still keep denying and I don't even want to get into it because I am so angry, but if they make my appeals run out then I plan on continuing to send them the same package over and over again so they can lose their money on paying the " independent Dr " (independent my butt) to review the same things over and over. > > I know, not very grown-up thing to do but I proved all their points wrong and I have been refused to right to meet with them to show them 's Mold and how he couldn't turn his head over. Big jerko company. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.