Ch 13 NOW $8,000+ in medical bills..

[nomoneyinsc]

We filed for Ch 13 and was confirmed. Payment is $975/mo which I am working on getting reduced as I am self employed and my salary has gone to crap with the recession.

My son had surgery in March. I had insurance on him and paid the $250 deductible AND got a letter from Blue Choice stating the surgery would be covered. A month AFTER his surgery the hospital calls me and tells me the ins co denied the claim due to pre exisiting conditions. Since I am self employed and we had a self insured policy on him there was a 1 yr waiting period due to the fact that he had this problem before EVEN THOUGH I have a letter from them saying it would be covered. I've dealt with hospital financing and explained my entire situation and they told me I do not qualify for any sort of help and I owe them over $8,000. The hosptial is a Bon Secours hospital and I've been told that they won't put a lein on your house or garnish wages if you can't pay.

Has anyone been thru this or know a similar situation? I've been told by the lawyer they can't include it since this all happened 3 mos after we were confirmed. I don't know what to do. I'm trying to save up money for a roof we desperately need and I did the right thing with the insurance and now this!

I need a break!!!!

[falken]

I would try to work out a payment plan with the hospital with as small of payments as you can, get the payment plan in writing and ask to be able to wait 60 days for your first payment. Hospitals are usually fairly generous with payments plans as they have a high default rate.

Since you are working on modifing your plan due to a decrease in salary try and also put this payment in to your new proposed budget. I don't know if this would work or not, but it seems like it should. Perhaps someone else can chime in.

[Ifonly]

I would spend every free moment I had harassing Blue Cross/Blue Shield. Even if they made an error in sending you that letter (I'm gathering this from your post?), it's THEIR error. Insurance companies live to try to "take back" benefits after they realize they actually have to pay out. Contact your local news, contact your legislator, contact anyone and everyone who will listen. I wouldn't be spending my time figuring out how I would pay, I would be spending my time figuring how to get THEM to pay. Be a thorn in their side.

[nomoneyinsc]

Yeah their response to calling them and telling them I have a letter APPROVING the tubes in his ears but declining the adnoidectomy (which we did not do) was that the approval dept doesn't look at the pre-existing conditions we may have on our policy. I told them it wasn't MY fault one hand doesn't talk to the other...
I've had my ENT fighting with them and their rep too. The last thing I want to do is give up and give in to $8,000 which I don't have and SHOULDN'T have to pay even if it's $10/mo for 100 years. It's principle as much as money in my opinion. I'm gonna try my best with the lawyer. Blue Choice blows me off and says "pre existing clause etc" every person I get.

[falken]

Yeah their response to calling them and telling them I have a letter APPROVING the tubes in his ears but declining the adnoidectomy (which we did not do) was that the approval dept doesn't look at the pre-existing conditions we may have on our policy. I told them it wasn't MY fault one hand doesn't talk to the other...
I've had my ENT fighting with them and their rep too. The last thing I want to do is give up and give in to $8,000 which I don't have and SHOULDN'T have to pay even if it's $10/mo for 100 years. It's principle as much as money in my opinion. I'm gonna try my best with the lawyer. Blue Choice blows me off and says "pre existing clause etc" every person I get.

Does the approval letter say it is contingent on anything? Any approval letters I have gotten have had some type of wording somewhere on it that says it does not guarentee payments and it is still based on other policy limitations blah blah blah.

If it does not then you should definatly fight it, if it does however you may not get far.

[nomoneyinsc]

Does the approval letter say it is contingent on anything? Any approval letters I have gotten have had some type of wording somewhere on it that says it does not guarentee payments and it is still based on other policy limitations blah blah blah.

If it does not then you should definatly fight it, if it does however you may not get far.

Doesn't say contingent on anything. Says the adenoidectomy was denied because there is a 6 month exclusion for the following conditions: adenoids.

[LuciluS]

My suggestion:

In your policy is a Section on Appeals. I believe you have 30 days to appeal a decision. Phone calls mean nothing to them. Put your Appeal in letter form along with the approval letter. Send 'Delivery Confirmation' from your Post Office. Cost is $.80 plus $.44 for first class letter. Post Office will send you confirmation of delivery with date and time.

Draft a letter to your State Insurance Commission and include the approval letter along with your Appeal. Carbon copy to Blue Cross with proper Group & ID # listed.

Better yet.....if you have acess to a fax machine. Call Blue Cross & Ins. Commission. Ask for fax number. Usually a fax machine will print confirmation of fax. I would fight this until Blue Cross pays the $8,000. Of course, if Blue Cross did pay the claim, their payment would be less than 1/2 of billed amount and you possibly may have not met your deductible or out-of-pocket expense for the year Yet. However, it wouldn't cost you $8,000.

Being as Dh and I are walking medical patients..no joke. I've appealed many claims and have won.

Good Luck

Luci

[lrprn]

Quit trying to work with BlueCross. They've already decided they found a loophole in your coverage and aren't going to budge. This is regretfully an all-too common occurance. Worse, often the agents who find a way to cancel your policy coverage for a legitimate event are even rewarded on their job appraisals. Unfortunately this is very likely a dead end at this point.

Some suggestions for you to try:

Call the insurance commissioner for your state. Here's a link - http://www.naic.org/state_web_map.htm - click on your state to get contact information for your insurance commissioner. Some are willing to go up against unreasonable denials like yours and challenge the insurance company to prove their claim of pre-existing conditions to deny coverage.

Contact your state congressional representatives to see if they will lend their weight to getting BCBS to do the right thing and honor your coverage as promised.

Lastly, as already mentioned, contact the major TV stations in your area. They are always scanning for local human interest stories and yours is right up their alley, especially since the person they are refusing to cover is a child. Many stations have a consumer reporter - this story is right up his/her alley.

I'm so sorry this has happened to you and your family. Until you can find another path to get justice in this situation, work with the hospital to find out what kind of reasonable payment plan can be set up.

Since the operation happened after you filed, you cannot add it to your original Ch 13 plan. However, you should be able to add the payment to the hospital as a new long-term expense when you file an amended plan. This could lower your monthly payment even further if the trustee approves it. Talk with your lawyer to see what can be worked out.

[nomoneyinsc]

I faxed a letter to the insurance commission. They called me a couple hours later to say they were getting in touch with Blue Choice and Blue Choice has 15 days to respond to them and they'll let me know the outcome.

I've emailed my lawyer and am waiting to hear what they have to say on the matter.

Thanks for all your advice.