Insurance won't cover treatment

Optimism
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First I will say that I have only posted one message since I've joined this community due to lack of time (I know, same old excuse) but I don't know where else to turn for help. My mother was diag. with Stage III NSCLC back in August. She got insurance through BCBSM in April of this year. I spoke to several people at BC and they said that since her policy started in April and she was not diagnosed until August that treatment WOULD be covered. We find out today, after 3 chemo treatments, that they will not cover it due to their pre existing condition clause. They also told the cancer center that they would cover it and the chemo nurse told us this before her first chemo treatment because I remember asking. I don't understand this at all, this is awful. Does anyone know of any steps I can take to fight this? Is there a health insurance advocacy group out there somewhere that can help us fight this? Any ideas are greatly appreciated.

7 replies

debra1

There should be a Dept of Insurance for your State.
Here is Texas there is Texas Dept. of Insurance and the website gives you who to call, and complaints. etc.
I would call the health ins. co and ask them for the number of the State Dept. that governs them. I just hate ins. companies. They are great it you never have to use your insurance. And we cant do without them.

simplyklb

Contact your mom's Dept. of Insurance. It's the office where your state insurance commissioner is.

Did your Mom have insurance prior to April?

Kristi

Optimism

Thanks for the replies Debra and Kristi, that helps! I will check that out. I am just so appalled that they can even do this when they told me her treatment would be covered. Although I knew better than to think their verbal answers were set in stone - they would not give me anything in writing saying what they told me over the phone. Kristi - no, she did not have insurance prior to acquiring BCBS of MI in April.

Ramona

I had similar problems with blue cross in california. This is apparantly routine for bc if what I heard from others is an indication. I cried a lot. It was devastating. I was already financially in trouble.
Got in touch with my congressman who gave it to the dept of insurance. It had more influence I think coming from him. bc had pre-approved with me as well. That was $12,000 worth of scans. I also called a wrongful death trial attorney who was very good at medical. He thought I had a case; apparantly so did bc as they did pay. They paid eventually saying they were in effect just being good guys saying even though they didn't have to but just because they had pre-approved.
They left assorted lab and docotr visits they didn't pay for that I thought they should. I sued them in small claims court. I won! They paid.

simplyklb

I thought that she might have been covered by HIPPA for extra measure. Please get in touch with your state's department of insurance and file a complaint. BC&BS does this a lot.

I know someone who went thru something like this with a different insurance company. She got it resolved and the insurance company is paying her bills.

Kristi

lyaeger

BC does this kind of thing all the time and you must fight it. With me it was my Avastin infusions. They 'pre-approved' to me and my doctor's office on the phone and then refused to pay because 'it was not medically necessary'. The doctor's office appealed and they stalled the appeal (even though there is a legal timeline on appeals) until the bill was over $100k and the doctor's office refused to treat me. I had to call the state regulators and file my own appeal before they overturned my case and paid - and this was for an FDA approved treatment for my indication. The point is DO NOT GIVE UP! They always try intimidation first because it often works.

Good luck,
Linda

Optimism

Well, we talked to BCBS on Friday and basically they say that cancer itself is a pre-existing condition because it could have existed before she started her policy. Any of you who have fought with BC about coverage - has this been their reason? Seems like they could say that anything "could have existed" before she had coverage. The BC rep said to send a letter to the appeals dept. and then added "good luck" at the end of her statement. Nice. We are sending out a letter today and I am going to contact the State Dept. of Insurance for help as well. Thanks again to all of you for your support. We are now worried about the level of treatment she may get without insurance as we are meeting with a surgeon tomorrow morning to see if they can remove the tumor. The good news - 3 chemo treatments shrunk the tumoe by 50%!!! That is wonderful news and we are thankful for that but this insurance nightmare is just beginning.

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