Insurance Story

[Bill Hall]

As many of you know, I had my surgery a long time back (Jan 01). Anyway, last September (8 months after surgery), the Cle Clinic sent me a bill for $20,000. Apparently, the insurance company (Blue Cross/Blue Shield) paid around $3000 for the surgeon, leaving me with the rest. I called both and tried to get it worked out, since I knew it was incorrect according to my policy. They told me to send a letter, so I did to both. Cle finally responded 4 months later, BC/BS never responded. So I called once each month for 4 months trying each time to find someone at the insurance company to help. I was stressed by their phone systems, since they make you wait an eternity. Finally, I found someone at BC/BS who actually helped. I paid my $737 balance just a few weeks ago (16 months after surgery).

 

[Ross]

Your story is not uncommon and I do hope Jennifer sees your post. She is having almost the same type of garbage happening to her and it's taking it's toll on here well being.

It took nearly 2 years for my billing problems to be resolved, so anyone experiencing the paper game, hang in there and don't sweat it, It does take forever for everything to get straightened out. The Foundation isn't going to close it's doors because of it either!

 

[Jennie]

YIKES!!

YIKES!!

Bill,

This is INSANE!!! And they tell us heart people to cut down on our stress?? I'm very glad that it finally got straightened out for you. My insurance sent me a letter saying they are footing my bill, but I am waiting for the evidence....

Jennie

 

[MarkU]

I have an Aetna HMO policy. After I had my AVR in December of 2000, I got a call from Aetna telling me not to pay any invoices until I got their final statement. True to their word within six weeks I got a final statement for only $500 as per my policy.
On the other hand my business partner has his family on Blue Cross Blue Shield. His wife had a hip replacement last year and he has had nothing but hassles with his insurance. Similar story in that he spends hours at a time on the phone trying to just talk to a real person. At one point BC/BS threatened to cancel his policy, and ended up almost doubling his premium when he renewed the policy last month.

 

[McCln]

Bill

Bill

And everyone else, I am still having trouble with my HMO Coventry. It is one bill for special services, which I believe is for the heart and lung machine, in which the insurance does not want to pay. I hope my issue will be resolved soon since it is also nine months since my sugery. HMO's have a problem of what they will and wil not pay in this day and age. Glad you had help and patience. I am trying to keep my head level while the caseworker is trying to resolve the matter.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve

 

[sylviayasgur]

hi all!
i am so appalled at how bc/bs is handling this whole thing for you guys.
we used to have them as our primary, but joey insisted on switching to oxford (freedom plan select_ no referral required).
lucky for us they covered just about all of joey 's bill.
i can't believe these insurance co's.
i wish you the best of luck. sometimes when you get the right person on the phone it's great...hoping for the best.
be well, sylvia

 

[JenniferO]

Just happened to run across this thread as I was browsing.

Bill: Since I had my surgery at Cleveland as well and was "out of network" I am still dealing with the bills. In actuality, I appealed to my primary United HealthCare of Utah and they agreed to cover the surgery as "in network." However, ironically, they completely denied Cosgrove's surgical fee of $12,180. I went to Cosgrove's financial advisor (Peg Judson) for help and she contacted the insurance company. The story she got was that they had paid the anesthesia bill to Cleveland Clinic but labeled it the surgeon's fee. Therefore, when Cosgrove's fee showed up, they claimed they had already paid it to another provider, i.e. Cleveland Clinic. This is still in the process of being worked out so we'll see. I've seen the statements from Cleveland saying "this is what you will owe unless paid by insurance" go down from $58,000 to a current $14,000. Still holding my breath to see how it all ends up. I have BC/BS as secondary but so far all they have done with the statements they've received is reject them saying that they haven't been provided with information as to what the primary paid and won't address the bills until they receive that info. I don't haVe a problem with that, but wouldn't you think Cleveland does provide that information when billing a secondary???

Well, this month's statement (on the 14th) should be coming any day.

Ironically, since our health premiums are going up at the office (surprise!), I was today appointed the official investigator/researcher to try and find us a new health plan. So, any suggestions from you guys who are particularly satisfied?

Seems I have heard a lot of good about Aetna . . . .

 

[Sunshine susan]

Brings back memories!

Brings back memories!

Boy, does this discussion bring back memories! I had ARV with St. Judes in Feburary 1999. Via my company, I have a Blue Cross/Blue Shield PPO which is actually BC/BS of Alabama as that is the home office of my company. However, I love in FL and our cards said BC/BS of Florida even though the correct number is on the back. (Not sure why they did that, but cards now changed to BC/BS of Alabama.) Anyway, the doctor has to have the insurance pre-certification an apparently the office staff certified mine with BC/BS of FL (probably in a pile of others and never caught the phone number difference) as that is who we got the approval letter from. Really should have realized then that there was a problem. When all was said and done and the bills started going to BC/BS of AL, they basically denied the entire surgery--ALL of it--I guess close to $300,000, because it wasn't pre-certified--AL didn't care what FL did, THEY had not certified it. It took a few weeks to get straightened out. Nothing like telling a heart patient right after surgery--"oh by the way, we aren't covering your claim..." Then on top of that, the anesthesiologist practice who had the only contract with All Children's wouldn't take BC/BS so had no choice but pay the 20%. Not much but again we didn't find out until the night before the surgery when one of them visited me in the hospital to tell me about the next morning and "oh by the way....". Man, they gotcha coming and going..... Susan

 

[Johnny Stephens]

My insurance is underwritten by my employer, but administered by Aetna. So far, there are no glitches in the paperwork as far as payment, etc.

We had a couple of very minor things such as physical therapy and in-home hospital bed that they initially balked at, but agreed to cover after a single phone call.

All in all, I'm pretty pleased with Aetna as administrator of the plan. No experience with them as the underwriter, so I don't know if it would be a different experience if it was THEIR money.

Your mileage may vary.

 

[Lisa in Katy]

As a former Director of Managed Care at a hospital, I can tell you that BC/BS is different in every state. However, no matter where they are, they are run kind of like a government organization, so therefore, lots of red tape. They weren't the worst that we dealt with, but certainly one of them. I argued with them this weekend about a bill for my mom. Certainly glad I'm out of the business and teaching 1st graders. Much less stress!

 

[joy]

HMO'S

HMO'S

I am having sort of the same trouble with my insurance, but i am fighting with them over who my cardiologist will be. I have Tricare, the military's insurance, and I guess It's supposed to be great, but not when it comes to which provider you want. The navy has the worst track record with me... but for the last year and a half, I have seen the same cardiologist, and now they are saying I have to go to Madigan. The one perk I have is that I have only had to pay $95 on all the stuff I've had done. Over $120,000 in hospital bills not to mention physician's bills. Pretty good for coverage.

 

[McCln]

My update on insurance

My update on insurance

I posted here recently bout the problem I had on one bill from surgery. Well, Last week, found out it will be handled by the insurance company and the surgeon. So finally, the surgery is paid. Yeah. Take care all.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve