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RyanPsych Donating Member (354 posts) Send PM | Profile | Ignore Fri Jun-03-11 09:30 PM
Response to Reply #6
10. I wish
that I knew for sure. Best I can tell- it is someone with medical knowledge that makes calls on whether a procedure was absolutely necessary or not. Basically- a tool.
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  -Blue Cross Blue Shield refuses to pay my little brothers $30,000 hospital bill RyanPsych  Jun-03-11 09:12 PM   #0 
  - Why? What reason did they give?  virgogal   Jun-03-11 09:13 PM   #1 
  - Why did they deny the claim?  The Velveteen Ocelot   Jun-03-11 09:13 PM   #2 
  - Their health care "expert"  RyanPsych   Jun-03-11 09:15 PM   #4 
     - Sorry to be dense but who was the 'expert'?  ChazII   Jun-03-11 09:23 PM   #6 
     - I wish  RyanPsych   Jun-03-11 09:30 PM   #10 
        - I had gynecological surgery  Horse with no Name   Jun-03-11 09:56 PM   #21 
     - Appendicitis kills. It wasn't a necessary expense to remove it?  haele   Jun-03-11 09:47 PM   #15 
     - No. The kid had a duty to die.  kestrel91316   Jun-03-11 10:03 PM   #23 
     - Easy enough to prove  Horse with no Name   Jun-03-11 09:51 PM   #19 
     - Stayed less than 24 hours, actually  RyanPsych   Jun-03-11 10:08 PM   #24 
        - that is medically appropriate. I'd challenge the expert. n/t  Horse with no Name   Jun-03-11 10:12 PM   #27 
     - BCBS did that to me and I won.  AmBlue   Jun-04-11 06:27 PM   #49 
     - Thanks for sharing that. It gives me (a bit of) hope. nt  BlueIris   Jun-04-11 08:55 PM   #52 
        - You're welcome & good luck!  AmBlue   Jun-05-11 01:06 AM   #53 
     - Please consider challenging this -- ask the brother's doctor and/or the admitting physician to help.  anneboleyn   Jun-05-11 01:13 AM   #54 
  - what's wrong? The Health 'care' industry, for starters, but it's a long, long list  ixion   Jun-03-11 09:14 PM   #3 
  - ACA makes claims denial perfectly legal  eridani   Jun-03-11 09:22 PM   #5 
  - They've appealed  RyanPsych   Jun-03-11 09:32 PM   #11 
     - Report it to your state insurance commission.  uberblonde   Jun-03-11 09:51 PM   #18 
     - Depends on the state  Horse with no Name   Jun-03-11 09:58 PM   #22 
        - They live in Texas  RyanPsych   Jun-03-11 10:12 PM   #26 
     - I have so much experience with this... start keeping records, get the doctors office involved to  NotThisTime   Jun-04-11 05:57 PM   #48 
  - How often and how long can this sort of thing keep happening before there is  enough   Jun-03-11 09:23 PM   #7 
  - For quite a long time, unfortunately, because most people will never get expensively sick  eridani   Jun-03-11 09:47 PM   #16 
  - they are selling a con job  RyanPsych   Jun-03-11 10:24 PM   #28 
  - They won't wake up because they just don't see it.  Mariana   Jun-04-11 01:14 AM   #43 
  - your family needs to call the local newspaper  rateyes   Jun-03-11 09:23 PM   #8 
  - If it gets that far  RyanPsych   Jun-03-11 10:37 PM   #33 
  - Who do you talk to when the "regulators" are actually industry cheerleaders.  pa28   Jun-03-11 09:28 PM   #9 
  - So glad we could mandate this broken system to guarantee the  obxhead   Jun-03-11 09:34 PM   #12 
  - Amen  RyanPsych   Jun-03-11 10:24 PM   #29 
  - Amen, seconded!  anneboleyn   Jun-05-11 01:18 AM   #55 
  - I had to appeal my claim...get the media involved, start with local media sources  HipChick   Jun-03-11 09:41 PM   #13 
  - Your parents need to get the hospital and the surgeon to appeal..just ask them.  likesmountains 52   Jun-03-11 09:44 PM   #14 
  - My Aunt works for Met Life as a Claims approver  DeadEyeDyck   Jun-03-11 09:49 PM   #17 
  - They also do it because they know most people won't fight a rejection  dflprincess   Jun-03-11 10:11 PM   #25 
     - how sick is that?  RyanPsych   Jun-03-11 10:25 PM   #30 
  - Tell the hospital to re-submit...they can get around anything...  Historic NY   Jun-03-11 09:54 PM   #20 
  - Shit like this REALLY pisses me off  The Unawriter   Jun-03-11 10:26 PM   #31 
  - When you get that rich  RyanPsych   Jun-03-11 10:29 PM   #32 
  - My mom is thankful for all your suggestions DU!  RyanPsych   Jun-03-11 10:39 PM   #34 
  - Initially denying a claim is one of the many practices BCBS tries to  Glimmer of Hope   Jun-03-11 10:56 PM   #35 
  - Ditto  gvstn   Jun-03-11 11:38 PM   #37 
  - This sh*t is really evil, isn't it? And it is going on everywhere, with every private insurer.  anneboleyn   Jun-05-11 01:23 AM   #56 
  - I just noticed that I haven't received a claim check that they  Glimmer of Hope   Jun-05-11 06:26 AM   #58 
  - Health insurance is nothing more than legal organized crime  Hugabear   Jun-03-11 11:08 PM   #36 
  - Is berating the poster is an appropriate action here?  Maru Kitteh   Jun-03-11 11:44 PM   #39 
     - I wasn't berating the poster  Hugabear   Jun-03-11 11:56 PM   #40 
        - That's a nice thing to do. It do completely agree with your point, too. n/t  Maru Kitteh   Jun-04-11 12:43 AM   #41 
  - What is wrong with this country?  Newest Reality   Jun-03-11 11:44 PM   #38 
  - These guys are also trying to foist an annual rate hike of like 22% on Oregonians  99th_Monkey   Jun-04-11 12:55 AM   #42 
  - Of course they do. They're not into the business of paying claims. n/t  Scuba   Jun-04-11 05:55 AM   #44 
  - I don't know your details or the insurance wills/won'ts in the policy, but check them!  1monster   Jun-04-11 04:44 PM   #45 
  - Start writing letters ... Cc your congressman  otohara   Jun-04-11 05:18 PM   #46 
  - maybe it was the end of a quarter and they had to make their numbers...  Gin   Jun-04-11 05:24 PM   #47 
  - Every BCBS in the Country should be investigated. BCBS is corrupt to the core.  glinda   Jun-04-11 08:15 PM   #50 
  - How would BCBS ever make money if they paid all these frivolous  vssmith   Jun-04-11 08:49 PM   #51 
  - well a lumpectomy cost $80,000, back in the 1970s I had my tonsils taken  StarsInHerHair   Jun-05-11 03:56 AM   #57 

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