Posted: 2/25/2008 1:40:31 PM EDT
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Had to have shoulder surgery couple of months back. Am covered with Blue Cross/Blue Shield from work and Tri Care Prime from being retired military. Required to fill out medical history, ect, listed everything as always. Had surgery, all ok. Got letter from BC/BS yesterday demanding $5,186 for cost of surgery because it was a result of injury in 2000. I was run over by a Hummer, sued the SOBs, rec'd settlement from .gov because of their stupidity. BC/BS say because I was paid for injuries they don't have to pay. Settlement was for stupidity, not injury. My shoulder was not injured, chest was crushed. BC/BS has no access to my X rays or medical records so how can they say shoulder was injured in earlier accident? Why did they not file claim with Tri Care? Will respond in letter stating this, any other suggestions would be really appreciated. Thanks |
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Suggest they contact TriCare? At least they paid. You have the upper hand. They might have declined to cover the bills. Or may demand a refund from the docs, in which case you'll be the second to know. Most of the above by way of taggage for the outcome. Good luck! What caused the injury to your shoulder? |
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OMG, BC/BS just got the $hit beatened out of them in Calif for cancelling the policy of a female breast cancer pateint in the middle of her treatment. BC/BS got tagged for $9 million big ones. And they got fined big time for cancelling other people's insurnace policies. Contrary to the TV commercials and print ads, BC/BS is not your friend when you need help. They are a money making enterprise that needs a high ROI for their investors to treat them accordingly. |
Just f'n wore out. All those pull ups, countless push ups, ( had to keep that 300 apft no matter what) ect, had to separate and trim arthritic plates and stabilize with a couple of pins. actually busted loose while hammering fence posts.
Thanks you, this is what I needed to know. |
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You probably have to get your med records from the original injury to show BCBS that the shoulder problem is not related to the accident. BCBS obviously believes that the two are related. What BCBS is doing is called subrogation. It is to prevent two separate insurance companies from paying on the same incident. If the med records show that the shoulder problem is not related to the original injury, you should not have to reimburse BCBS for the surgery. |
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As descibed it sounds winnable, but it will take time, and patience. Send copies of your correspondence to your state insurance comminsioner--complaint department, or whatever they call it. They probably have a "hot line" or whatever, for complaints. Note on your correspondence to the insurance carries, that you are copying the State Insurance Commissioner. Keep copies of all correspondence, obviously. If you lawyer up, the legal fees at $2-300/hr will quickly eat you alive. Good luck! In my state, Az, it gets real complicated when third parties are involved, and judgements are awarded to the injured. There's a real feeding frenzy for the care providers to recoup their fees from the settlement. Not exactly your situation, but similar. |
I listed the injury as medical history. I was already retired when I got ran over. I was wearing BDUs. Active Duty MP did it. |