Guest guest Posted January 18, 2004 Report Share Posted January 18, 2004 Dear Kay, Tell them you want a review or hearing on the case. I had that happen with several insurance carriers over the years. I represented myself always, even for larger cases. I won them all except for one, for which my doctor put down a wrong diagnosis (what a fool he was, I must say). Be aware though, it can take years in some cases and the hospitals harrassed me terribly for the money during that time. I did not pay though, as some of these bills cost several thousand dollars. The exact same problem as you had, they gave an ok on the phone and then didn't pay the bill. If you have the name of the person you spoke to, and the date and time you spoke to them, you have a chance to get it covered. The usually record all conversations and if it goes to hearing, they will have to produce the recording or you can request it. They will usually require you to send in a written request for a review, and you have to use everything you can possibly think of on your side of the argument. Having given them the diagnosis code, they should have not made this error. It is their responsibility to know the conditions of coverage when you call. Very important, when you send anything in to them, send it certified (or registered), I forget which (PO will know), but also get a RETURN receipt so they have to sign for it, proving they received it. Insurance companies will try to tell you that you didn't meet the time requirements (either 30 or 60 days sometimes and this can be from date of original submission) and deny the claim before it even gets to review. They did this to me several times, and when I sent in the signed return receipt, they had to immediately open the case. I always keep records of everyone I call at these companies, and I write it on the bill (I make a copy first) so I cannot lose it somewhere around the house! If I don't attach it, i'll surely lose it...I have way too many papers! A word to the wise, if you do get it covered, keep the records for a long time. In one instance, they billed me again 4 years later! I threatened them with harrassment and double billing and wouldn't you know, the payment record turned up right away when they received a certified letter telling them my lawyer would contact them regarding these issues. Best of luck, hope this helps... Debra! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2004 Report Share Posted January 18, 2004 This sort of thing makes my blood boil. I was in the insurance business for 30+ years. Go to your state insurance department and ask to file a complaint. Give them every piece of documentation you have and explain the problem so it can be easily understood. They should fight for your rights. Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2004 Report Share Posted January 18, 2004 Second thought, I always called the president of my Blue Cross Blue Shield. Seems them get more serious about things when he/she is being bothered. Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2004 Report Share Posted January 19, 2004 In a message dated 1/18/2004 7:52:52 PM Pacific Standard Time, jbrpol2@... writes: called the president of my Blue Cross Blue Shield When we were in Group Health, when I would encounter difficulties, I would call the Director for our region. Everytime, the 'problem' was resolved in my favor. I did get tired of the baloney and the constant fights with the insurance company. Kay, I so feel for you! K (the other one Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2004 Report Share Posted January 21, 2004 A Blue Cross supervisor called tonight. I was quite surprised that the took the time to return my call. She tried to make it seem my fault that they had given me misinformation. The diagnosis code was for Achilles tendonitis. She said when they are given the diagnosis code for physical therapy that they don't know what part of the body it is for. She said that they are not doctors. It seems to me that Achilles tendonitis is specific. She said I should ask more questions. I said I was given an unqualified " Yes, its covered " . If they had given me complete information I could have gone through the proper channels for foot care approval. It seems to me that it is their responsibility to ask necessary questions. The supervisor seems to have a record of the call and their approval. At first she said to send it to appeals. A few minutes later she called and said that she looked up " Achilles Tendonitis " in her medical dictionary. She said it pertains to the leg. DUH! She said to have the hospital resubmit the claim saying that it wasn't foot/ankle care and say it was physical therapy for my leg. Seems a crazy system that thinks the foot, ankle, leg are isolated body parts. Overall, it was just one of those conversations that left me shaking my head. I know this incident may seem minor compared to the problems that many of you are facing but its an example today's wacky medical insurance system. Kay Quote Link to comment Share on other sites More sharing options...
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