My health insurace company is givng me trouble!!!???

I have blue cross blue shield from Ford Motor Company where I work..I went out of the country and had to be hospitalized I ad to pay about 5,600 dollars and theyre suppose to pay me that money back...What should I do?
Additional Details
I am covered and its not extra ... I have reciepts and everything.........they do cover out of country hospitalization

Actually, its not that unusual for an insurance company to cover medically necessary/emergency services rendered outside the US. I used to work for 2 different large insurance company (one of which actually used to be a part of BC/BS, then became its own separate company). It was a standard part of all policies to cover services rendered outside of the country...no special rider was needed.

(And I can't believe that someone who is an agent would never have heard of such a thing! Perhaps they should check more closely with the companies they represent in case the question ever comes up with one of their clients.)

This is how a person would have went about getting reimbursement from the companies I worked for:

Get an itemized receipt and description of services rendered. (doctor or hospital notes, etc.) If the documentation is in a foreign language, get a translation and send it in with the records. (This will speed up the process for you...if you send notes in a foreign language to the insurer and they need to find a translator, it just makes it take that much longer for you to get your money back.)

Payment would be made for services that would have been covered for services rendered in the US, according to your benefits on the contract. (Ex - if you have 80-20 coverage, reimbursement would be made at 80%, following whatever exclusions might be on your contract, etc.)

At the companies I worked for, the nurses in Medical Review would take a look at the documentation/translations, and then forward the information to claims with authorization to pay for the service. Since there would be no "usual customary rate" for foreign doctors, claims were processed at billed charges using the exchange rate in effect at the time of the service for the currency type of that country.

Have you sent all of the documentation to BC/BS? I'm confident that you should be able to get the reimbursement due to you once all the documentation is submitted. I'd clarify from your insurer exactly what paperwork is needed and KEEP COPIES for yourself. Also, make sure that your name and insurance ID number are clearly indicated on all of the pages, in case they get separated.

Wow I use to work for an insurance company and I have never heard of Blue Cross Blue Shield insuring out of country hospitilization. Did you buy a special rider? I guess you must have because thats not standard with their policies.

Im thinking they are giving you trouble because you are not covered. When you went overseas you would have giving your coverage notice to the hospital that treated you and Blue Cross should have paid it before you were released. Thats weird, ive never heard of that before.

I bet your not covered or you would have had your money already. But they are just making sure.

*update*

SLS is right but only for her company. I worked for a fortune 500 company and I was sent overseas maybe 5 times a year. Every time I went a week before they would buy me a rider. Its too expensive to always have that coverage. Unless you are travelling out of country once a week. I dont know what companies she worked for, but I know its not a standard policy. And you should never travel overseas without knowing. Thats your first question. And I do agree with SLS about why an agent that has been an agent for 21 years has never heard of these.

Also check with your credit card, some credit cards or travel agencies included an overseas health insurance policy if you use them, hell you might not even know it.

Make some phone calls.

The question of coverage all depends on the plan you have. So, it's impossible for anyone else unfamiliar with the details of your group coverage to answer your question.

However, even if there is coverage for services rendered outside the US, they do not always reimburse for the full amount (unless that's been specified under your contract -- which is a possibility for such a large account.) Ultimately, you're going to have to see the benefit folks at work to answer your questions.

Keep in mind, though -- it does typically take AT LEAST 30-60 days to process the reimbursement paperwork.

They're supposed to pay you back? NEVER heard of such a thing. NORMALLY, they would only cover life threatening emergencies if you're out of the state, and NOTHING if you're out of the country. Even if they paid SOMETHING, I have NO DOUBT that the charges are NOT through an "in network" provider, so you're looking at MAYBE getting HALF of "usual and customary" charges back, LESS your deductible. AT BEST.

So, I'd go to whoever told you they are going to reimburse you for your expenses - and ask THEM when. Because I'd strongly suspect that they are WRONG.

call the president of blue cross

pretend you are an investor to get his phone number

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