My work changed from BCBSIL to BCBSAL...post op...Not Covered

[lisaholland73 197]

So my work changed from Blue Cross Blue Shield of IL to Blue Cross Blue Shield of Alabama, they told me (and I have an email) that it was not excluded from the new insurance. My husband who got the surgery a year (2013) after me (2012) went for a fill under the new insurance, not covered!!...They DID exclude it from the policy. So my question is (1) since the company's policy covered me for the surgery in IL, could they not have a case by case exceptance for us now that we have follow-ups to go (2) since they told me in writing one thing and now it's different do I have a leg to stand on to try and fight for them to cover it, since they already paid for the major part??

The bill for a fill is $1066 not covered by insurance, the doctor's office said they could charge me $175 the cash price. What a crazy difference. I just want resolution or an answer from the company, I sent a letter to the Benefits Manager but still no reply. Hoping if I have to pay the cash price my flexible spending will take care of it.

Thanks for listening.

[mrsto 2,925]

Lisa - that is a total drag. There is so much upheaval with health insurance right now. And that is SO ridiculous that your doctor charges the insurance company $1,066, while the cash pay is $175. Does he do fills under fluro? Unbelievable!

In answer to your question about flexible spending, there should not be an issue having it paid from that account. It's a medical expense, and that's what the flexible spending account is for.

I asked the insurance person in my doctor's office how much a cash pay fill is. It's $250. I'm still covered for bariatric, though, but I was interested since none of us know from day to day, what will be with this insurance mess

[mrsto 2,925]

PS: And that's not under fluro! I'm in there 10 minutes, and it's $250. Go figure.....

[Alex Brecher 10,516]

PS: And that's not under fluro! I'm in there 10 minutes, and it's $250. Go figure.....

That's a pretty average/reasonable price for a fill.

Your case might be considered a pre-existing condition and your insurance might be forced to cover even if they have a WLS exclusion. Let us know what your Benefits Manager says. I'm really curious!

[terrydumont46 1,954]

once you contact your insurance company with a written letter . cc a copy to your insurance commissioner. the insurance company might be doing something illegal and they really hate it when the insurance commissioner gets involved in cases. it won't hurt.

[mrsto 2,925]

PS: And that's not under fluro! I'm in there 10 minutes, and it's $250. Go figure.....

That's a pretty average/reasonable price for a fill.

Alex - that's good to hear. There was another thread awhile back, and when compared to what others said they "cash paid", it seemed on the high side. Then again, I think location may be a factor. In California (and NY), everything is more expensive.

[lisaholland73 197]

Thank you everybody for your advice and support. I knew you guys would understand. I will keep you posted. I'm so glad my husband and I have already gotten the surgery. I'd be even more upset if I hadn't gotten this far.

How do I find out who the insurance commissioner is?

Thanks again!

[mrsto 2,925]

Lisa - here you go.... http://www.aldoi.gov/Commissioner.aspx

[mrsto 2,925]

Lisa - are you located in Illinois or Alabama? The insurance is by state. If you're in IL, you may need to contact the commissioner in that state. You'll find all states on this link..

http://www.insuranceclaimsconsult.com/Ins.Commissioner.htm

[lisaholland73 197]

I'm in Illinois, Thank you for the info!!

[cheryl2586 3,053]

I have really good insurance from my job but the thing is they won't pay for a fill but will pay all the cost if I am willing to change to another surgery the bypass or sleeve. Heck no I will stay just like I am but if I want a fill the doctor charges 500 just to see him and 195 per fill. This little thingy in my stomach is expensive.