Twas the Night Before Surgery When BCBS Insurance Denied...

Montana_Expat

I was diagnosed with Stage 1 DCIS two years ago, and my whole family got right on it. My sister, an MD/PhD and a 37-year breast cancer survivor (she's also a published researcher) helped me navigate treatment options. I followed my insurer's instructions to get pre-approval for my mastectomy and reconstruction, and I flew all the way from Montana to New Orleans to have the procedure.

The night before surgery, I was informed by phone that Blue Cross/Blue Shield of Montana (same company as BCBS of Illinois, Texas, Oklahoma and New Mexico) denied their previously approved coverage for the unaffected breast.

I was floored (I mean that literally: ask my husband, who picked me up off the hotel room carpet!)

I forged ahead anyway--and I'm glad I did. The Breast Center in New Orleans was very supportive.

Look, I've read some gut-wrenching tragedies on this forum. This isn't one of them, and I feel awkward bringing this up. It's not 'life and death.' I did get a lawyer, and I am fighting, but I've read several accounts that confirm I AM NOT THE ONLY PERSON TO GET A LAST-MINUTE DENIAL.

Long story short (my bill was so huge that now BCBS is claiming they decided to pay that portion of the surgery after all--they just never bothered to notify me that they (eventually) changed their minds: my bill is intentionally ambiguous and the finance office at my surgery center is still in my corner).

I am hoping to find out if this is a pattern of behavior for BCBS. This needs to be stopped.

Anyone out there who experienced something like this?

Thanks,

MT_Expat

Tomboy

Whoa! That's outrageous!

BellasMomToo

Thanks for sharing. I have BCBS of Illinois (my husband's employer is in Illinois) so your experience really concerns me. I would be livid too.

They haven't done anything like that to me, but they did randomly reject one of my chemo charges (my MO's office had to resubmit and the resubmission was approved) and another time they sent us a rejection letter re: a different chemo charge but the MO's office confirmed that BCBS did pay that 'rejected' charge.

Rrobin0200

I am from the NOLA area with BCBS as my insurance. I, too , was denied coverage at the Center of Restorative Breast from BCBS. It turkey was a blessing in disguise as I wouldn't have found my incredible doctors that did indeed accept my insurance and the results are better than I could have ever dreamed kf

Montana_Expat

Thanks for your stories and support.

I hope I get more responses: please post something if you have had a similar experience, so this thread might help another double victim (cancer+insurance issues), sometime. I did find one woman who had reconstruction surgery denied at the last minute, but she had originally had her implants for cosmetic reasons, not cancer...She was experiencing immune issues, though, and STILL, her Idaho insurance company gave her a last-minute denial...

GreenEyes81

Oh wow...I am sitting here in Montana trying to decide what insurance to get starting in January which will be my reconstruction "coverage". Just emailed Nola with questions as well. lol

Good luck!

edwards750

Idk if other insurance companies are notorious for denying coverage but I have BC/BS of Tennessee and they did deny coverage after the fact for my Oncotype test. It was a 5k test. They ended up paying it and Genomic Labs said they do that all the time. Go figure.

One thing I learned is challenge them and be persistent.

Diane

Herculesmulligan

I'm so glad you posted this. Bcbs of PA denied part of my genetics testing after preapproving it. Then I appealed and they denied it again. But so far the hospital hasn't billed me. So I haven't taken further action

Montana_Expat

BCBS of Montana, BCBS of Illinois, BCBS of New Mexico, BCBS of Oklahoma, BCBS of Texas--they are all displaying pattern of behavior (and I'm spelling out all these states on this forum, in case anyone searches for their home state in our chat room)

BCBS of Montana also initially denied my Oncotype testing. I went ahead with the Oncotype, which was a pivotal variable for me in deciding whether or not to have chemo.

BCBS did not inform me, but at some point, they decided to cover the test.

Gee, thanks.

Their 'Deny First' policy needs to be exposed. Remember, BCBS has nothing to lose by denying us. A certain percentage of women will forgo testing, or pay out-of-pocket, which means more profit for BCBS' bottom line.

Health Services Corp., the parent company of these insurers, is making a nice profit, at patient's expense. I can't post a link here, but check out Crains March 17, 2017 post "Blue Cross Parent Stops the Bleeding..."

It's cruel to shout "No!" at the front door of a breast cancer patient, hoping we'll roll over...Even when they acquiesce, BCBS whispers the news through our back doors--I only found out they covered the Oncotype when, after weeks of denial, I looked online, and there it was...

Ask around. If we can display a pattern of behavior, we may have a class-action against BSBS

SummerAngel

BCBS of Washington state covered everything for my treatment without question.

If an appeal was made and the procedure eventually covered I don't see how a class action suit would be possible.

pingpong1953

The longer they can hold on to your money the more interest they make. Seriously, a cancer diagnosis is stressful enough without this nonsense.

edwards750

It can’t SummerAngel. Kind of contradictory anyway.

I have had to appeal insurance charges but it’s the insurance world we live in.

Diane

Montana_Expat

I am glad you weren't denied coverage, pingpong1953. Despite the similar name, BCBS of Washington is not the same company as this one (Health Services Corp.), though.

Even if they pay up eventually, if an insurer has a DENY FIRST protocol, victims suffer (at least for awhile) and insurers benefit. It's wrong.

I look at the junk mail I get about class action lawsuits (hey, I'm a retired jeweler, not a lawyer!) and I got to thinking...I remember an old Joaquin Phoenix movie where that was part of the plot line--send me the name of that movie if you remember, it's driving me crazy.

We may not have monetary damages or health consequences (some of us might!), but we may get some legal traction (or a plot for a Hollywood movie).