Blue Cross Screwing Me Around | Arthritis Information

I've been getting Remicade for months and Blue Cross has faithfully paid. In October I changed jobs and went on COBRA (in California) coverage until my new insurance kicked in. Blue Cross has declined my claims now! They say they have had my claim analyzed by another "provider" who has recommended my treatments were unnecessary! This is ,000 later!!!

Help, who do I call about this? What are my options?

Sorry to hear of your troubles Randy. I have no idea the answer to your question, but just wanted to say sorry and hope it gets straightened out soon.

The cobra plan is the same plan you had with BCBS. If you are still on the
cobra from the BCBS, it should not be different. Who analyzed the plan? Did
your doctor say it was unnecessary? Your doctor is the one who will decide
if it is necessary. Your MD needs to write this company a letter and
straighten it out. You cannot get a drop i coverage because you switched to
the cobra plan. Please check this out with your insurance commissional.
This is an ERISA law. I'll get you that website.: You may be able to file a
complaint with them.

http://www.dol.gov/index.htmHillhoney may also be able to answer yer questions. She knows about
insurance stuff. Your prescribing doc needs to contact BC/BS and state why the med is necessary. That is rediculous. I worked in HR for many years and COBRA must have the same plan as you had prior to changing jobs.Randy, I am sorry you are having this problem. They are making a mistake and you have to fight them on this! They are hoping you will just give up and they won't have to pay for this any longer.

First, I would contact them, explain the circumstances, how long you have had this policy, when you began COBRA, etc. and require that they send you a letter stating exactly why they are now denying your claim, after you have been receiving coverage for this medication for some time. Also ask them to fully explain their appeals process, and notify them that you will be taking this to a formal appeal.

Now here's the most important part of your letter - put a carbon copy notation on the bottom for the Insurance Department of The State of California. Make sure the insurance company can see that you are getting the Insurance Department involved. And make sure you send a copy to the Insurance Dept. Complaints Division.

This is important, because insurance companies are required by law to respond to inquiries involving the Insurance Dept. It should assure that your letter will receive the proper legal attention, and put them on notice that you are prepared to fight and fight hard about this. Hopefully they will back down and blame it on a clerical error, but if they don't, you will now have the Insurance Dept. involved, and still have the appeals process open to you.

Do all of this a quickly as possible. And make sure you provide all relevant information - policy number, group number, etc. and I would also send a carbon copy to your former employer's benefits department to keep them abreast of the situation.

Good luck to you and keep us posted.

Randy,

Blue Cross is involved in a huge lawsuit - the situation is so bad the DOCS are joining the suit - can you imagine that?

http://www.latimes.com/business/la-fi-doctors27dec27,0,71802 58.story?track=tothtml

Hope this helps,

Pip

Great article, Pip. I don't understand why we have to fight so hard for everything.

Sorry to be negative (again) but I think they think they can get away with it because we're sick and we'll run out of energy before they do.

Randy, I forgot to say, you're in Cali, contact one of those class action lawyers mentioned and get in on the suit. While the doc's and the lawyers will get most of the $ when BC/BS settles, maybe you can get enough to stashed for later.

Pip