INSURANCE PUZZLES

 

July 16, 2013     INSURANCE  FIGHT  DAY  ONE

Phoned BCBS to request an Internal Review regarding their denial of the diagnostic Biopsy.  Malayka initiated a review and gave me the reference number for future use.  She also instructed me to contact the facility where I had the procedure to let them know that the claim is under review and to give them that reference number.

Phoned MWC billing department, waited FORTY-FIVE MINUTES before someone answered the phone.  I forgot to get the woman’s name who attended my call, but, I gave her the reference number and she put it on my account.

Aside – while speaking with Malayka I asked her if I was going to have to fight with them about getting the mastectomy.  She put me on hold while she talked with a supervisor.  When she came back, she told me that I need to phone my surgeon and ask them to fax to the insurance company a pre-determination along with medical records.

Phoned Surgeon’s office, the first office girl had no idea what I was talking about and she gave me the Finance Counselor’s direct line.

Spoke w/ Tara, Finance Counselor, she knew exactly what I was talking about “pre-determination”.  She did not have any of my information yet since the surgery is not scheduled until August.  She was going to walk down the hall to the Surgeon’s office to get whatever records she would need and asked me to fax to her my list of strong family history of breast cancer.  Done.

 

 

July 15, 2013     EVIL  INSURANCE  COMPANY

I need to bookmark this link to my State’s Insurance Commissioner since I have just filed a complaint against my health insurance carrier who is refusing to pay for the biopsy service because I have breast implants.

http://www.ok.gov/oid/Consumers/Consumer_Assistance/File_a_Complaint.html

Yes, there was a rider that I had to sign when I bought my insurance policy, that covered the breast implants and any “problems” that might be associated with them, the insurance would not cover any procedures, such as cosmetic replacement, or leakage problems, etc… BUT, breast cancer is cancer of the BREAST, not cancer of the IMPLANTS!!

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