Quote from: Eva Marie on December 29, 2014, 05:55:31 PM
Either it was a real mistake and the surgery is not covered under the policy OR someone at the insurance company woke up to the situation and decided to deny coverage for something that should be covered. My money is on option #2 being the case. I've had my own fights with blue shield just to get them to cover some therapy and it was a battle royale. I have a feeling that we are going to tangle again when SRS time rolls around. I can't stand health insurance companies!
My € is definitely on #2.
I am not with BC/BS. I am with Emblem Health/GHI (wife's plan). They cover therapy but the amount is a pittance. My previous therapist asked for a $140 copay per session, and the ins would pay $55 to them. My new therapist charges less but doesn't take insurance.
One of my dr appts prior was billed as a physical. Denied! They don't cover physicals for anyone between ages 19-40. Truth be told it WAS a physical, as I had all my meds checked, blood pressure, blood work etc. So they had to bill it as just a regular visit.
HRT prescription? Denied! You're a male, you shouldn't be taking estrogen and we won't pay for it. No worries, I'll fix that this year! Meanwhile walmart, target and costco have it at low cost. Good thing I'm not taking finasteride, because that will be denied when I change from M to F on the policy. The insurance used to be covered by the union but now they went to Innoviant/OptumRx.
Even my kids were denied medicine for respiratory issues, but this was on my job's plan (CVS Caremark). A call to HR did fix it though. My HR dept has been totally awesome with everything. But CVS did it in a real scammy way. They waited until they were over the age (4 months) to get it, then denied it saying they were outside the age range they'd be covered.
I hate dealing with insurance companies!
