A breast cancer survivor shares her experiences with the BRCA gene.

Wednesday, December 17, 2008

When Insurance Doesn't Pay (as Promised)

So, here I am, sitting on eternal hold with my health insurance company, BlueCross BlueShield of Georgia, and listening to the taped message featuring cheesey Christmas music and a perky woman's voice letting customers know how much BCBS cares about us and is there to help. Hmmmm...

"We're looking forward to assisting you!" I'm not sure they want to hear from me today.

I just received a letter from BCBS stating they were denying my appeal to fully cover genetic testing at Myriad Labs--to the tune of $1,000--even though I had produced a letter on BCBS letterhead and signed by William Tatum, MD, Medical Management, BCBS: "We have approved your request to receive care as described above."

Yet, now, BCBS will not accept this document. Go figure.

I've been speaking with Veronica in customer service, who can't answer my question of why I've been denied coverage when I have a letter in-hand stating otherwise. Because Veronica is perplexed, she puts me on hold to find a supervisor.

10 minutes later..."Your call will be answered shortly! Thank you for holding!"

My plan of action, therefore, is to get tough. I'll stay on hold all day, if need be. I'll take this to the top of the insurance company. I'll write an editorial. I'll call every day. I will get this resolved.

20 minutes later..."We do respect your time! Please continue to hold. We will be with you as soon as possible."

It's amazing what you learn when you've been put on hold with your health insurer. I now won't eat too many sweets during the holidays due to diabetes risk...Cold season is here, and antibiotics are not an effective treatment since colds are caused by viruses--rather, drink plenty of fluids, get rest and use an over-the counter cold medicine, if needed...Several ways to reduce getting the flu include wash my hands and cover my mouth/nose when coughing; avoid people with flu-like symptoms; stay home if I don't feel well...Wearing heavy backpacks may injure your child's spine. Limit loads to 10-20% of your child's body weight....Keep fitness goals during the holidays by playing holiday music while working out!

30 minutes later..."We hope the New Year brings happiness and health!"

I'm wondering if they are starting to forget about me. Maybe this is another tactic to avoid paying -- keep me on hold forever so they'll never have to address my proof of a signed document by them.

At this point, I've been on hold for over a half hour and I've heard the recording about the cold season for the 50th time; therefore, I think I shall call them back...

My next call produces Mindy in customer service. She reviewed my information and said that although BCBS agreed to pay for the billed amount of the services, unless there was prior authorization saying they would pay 100%, they would only pay 70%.

Am I missing something here?! They agreed to cover the billed amount on my document, and now they are telling me that I needed to have some additional, special authorization for them to cover 100%. Of course, neither the lab nor I were aware of this. Somehow, I figured "paying the full bill" meant "100%", but then again, I don't know insurance lingo.

Mindy puts me on hold again, and I'm thrust back to "Deck the Halls" and "We appreciate you holding" message while she seeks further information.

I've now been on the phone with her for 15 minutes (for a grand total of 45 minutes)...

Mindy returns and, yep, I not only missed my appeals window of 180 days from the claim (in February)--although I didn't hear the first word about it until October (doesn't matter, said Mindy)...but also, the document I have in hand that states full coverage is negated by the fact that apparently I don't have yet another document saying they will pay 100% coverage.

Consequently, I must go back to my genetics counselor and the genetics lab to see if they can produce the required additional authorization.

No problem. I had nothing better to do anyway today.

1 comment:

Erica said...

Hi Julie - Two words. Call Myriad! I'm a genetic counselor and work with them all of the time. I have been told by our reps to tell patients not to worry until they get a bill from the lab directly. Sometimes they will fix it with the insurance company and sometimes they will eat some of the cost if they did not fully make you aware of the out-of-pocket expense. Let them do the legwork for you - they have a lot of experience and it's their job! You can contact their office at 800-469-7423. Hope this helps and good luck to you! Erica