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Belinda G | How can I get my HMO to pay my Medical Bills? |
Hired at a hospital with Medical Coverage. The insurance is Blue Cross Adminstrators They Have not paid my Medical Bills which total over $5000. They ask me to fill out a form of previous coverage in which it took 4 mouths to receive. I mailed the form back now, the Doctors and Hospitals are threaten my credit Because they have not received payment. I can not afford to pay the bills I can not find a Lawyer to take on the insurance company. The insurance company have the upper hand and it is very costly to sue. What can I do? I found that this is problem that eveyone with health care coverage is facing. |
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Suzanne: YPA
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As previous answerers have suggested, getting your HR Department involved may help. However, they have no authority to compel BCBS to explain the delay -- or to tell the providers they cannot bill you.
I suggest you contact your state's insurance commissioner's office in writing to file a complaint. Write a letter explaining the problem and attach photocopies of all documentation you have, including the bills and the form you completed. Then, fax your complaint to the commissioner's office. They will investigate this matter and, if BCBS is violating any of your state's insurance laws, the commissioner has the authority to compel corrective action. The process is entirely free.
After you've filed the complaints, send the doctors letters with a copy of your complaint attached. This will show them that you're doing everything you can to resolve the claims. |
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hightechchic
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Actually, it sounds like the problem is that you were hired and added to a policy; however, not every policy has a waiver for pre-existing conditions during the first 12 months of being on the policy. Some do, but not many these days. I say that is probably the problem based on your statement that they asked you to fill out the form about your previous coverage.
Since you did fill out the form, I take it you did HAVE previous coverage? By which I mean that you were listed on another group policy, or an individual policy with creditable coverage (this is an important point because "guaranteed issue" policies do not have creditable coverage)? And was there any longer than a 63-day gap between the two?
If you had previous, creditable coverage with less than a 63-day gap, it sounds like your documentation has been lost.
You definitely need to get your Human Resources dept. involved at this point, if that is the case. The documentation they requested of you should have been submitted with the original paperwork adding you to the group. And if that doesn't help, your state insurance commissioner's office will almost certainly have some assistance to offer.
However, if you did NOT have previous, creditable coverage (your HR dept. can help you find out if it was creditable), or there was a lapse of longer than 63 days, it's entirely likely that the company is going to deny paying the claim. (Again, check with the HR dept. to see if there is a pre-existing condition exclusion for the first 12 months you're listed on the policy.) |
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larsgirl
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with an HMO you can ask for a formal review. IF you work at the hospital.. have the HR dept force the issue.
it's almost like meeting in a judge's chambers... state your case.. have all your stuff.. including the credit bureau letters. They'll act.
They tried to get out of paying for my test strips, told me they were durable medical goods (could be used again).. A friend of mine worked for BCA.. told me about the review process. when I met with them.. I asked the guy in charge if he minded if I checked his blood sugar... I think he was in shock, because he et me.. put his blood on the test strip and tested his blood.. it was pretty good for someone his age.. then I handed him the test strip and asked him how I was supposed to use it again??? The claims were paid in under a week.
Good luck |
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chimneygod
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Get your human resources involved. They can help |
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Nette
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I deal with Blue Cross everyday and they are going to do this annually. Call the customer service number on your card tomorrow and tell them they they are not paying your claims because they state your COB info is not updated. Tell them you've mailed it in and ask them to update it over the phone. Usually they can if you don't have any other coverage. If they say the can't ask them the website you can go to do download the forms. Stay on the phone with them until you get to the correct site. Print it and take it up there to them - if they are out of your area ask for their fax number and call to confirm they received it. If you can't get anyone to help you ask for a supervisor. Once they have received your info ask them to reprocess your claims. They should to this with in 7 - 10 days. Once you get this confirmation call the providers billing office and tell them that Blue Cross is reprocessing your claims and they said to give them 7 - 10 business days. On day 7 go online and check the claim status to make sure your claims have been reprocessed. If they haven't call the supervisor again. Remember to document everything and go up there if you have to. Good Luck! |
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Custo
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well... if they received your pre-existing paperwork, why haven't they paid the claims?
Are they saying the conditions you were treated for were pre-existing conditions? Have you given them your HIPAA certificate of credible coverage from your last insurance?
They're not just ignoring you... there's a problem somewhere... You need to find out what the actual issue it... Speak with HR, or call BCBS customer service, and spk with a supervisor... It'll work out.
Call the doctors, and tell them you're working on it...
I've worked in health care & insurance for 10+ years... You need to find out what the presently occuring problem is with the bills... That will tell you how to fix them. |
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Dandouna
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I work in insurance and financial services and in my experiance- Blue cross is one of the worst, most disorganized insurance companies. Yes, they offer good services as far as insurance goes but the customer service is much to be desired. Get proof of previous coverage from your past insurance company (if you havent already) and fax it to them directly- ask for proof that they recieved it and call them up an hour after you send it. I find it helpful to ALWAYS talk to a supervisor and always get there name. Document everything with specific names and dates and times. THat way if you have to call them again- you will say you talked to "john Doe" on "3/3/07" at "11:04" am.... If they know you are organized and keep your facts straight then they will do there job. |
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