My Leg is Falling Off..
Wellmark Blue Cross is Denying Service
Very time sensitive
Immediate attention
Thank you for reading my plea.
My name is Tim Taffe, I am 63 years old and I live in Iowa City.
I am writing you since I have exhausted every possible resource.
My problem has to due with multiple right hip replacement surgeries, all performed in Iowa, at Burlington General Hospital and Great River Hospital. Next Monday I am scheduled to have the third replacement installed at Fort Madison Hospital, by the previous surgeon, Dr. Mitchell Paul, whom I trust and value.
My surgery is scheduled for next Monday August Fourth.
The first device was manufactured by Depew Corporation. It dissolved, and attacked my bones. This is called polyethylene disease. The replacement device was sold by Zimmer Corporation, and the product has been withdrawn from the market. The device has shifted.
There is now no connection between my leg and my hip. Only muscles and soft tissue keep me connected.
I am in great pain, I cannot sleep well, and I walk on two crutches. My right leg is now two inches shorter than my left. A few years ago I could play tennis very well. Now I cannot walk.
I will be attaching a letter from Dr Paul herein, he describes my serious health jeopardizing situation.
The point of this letter is that Wellmark Blue Cross Blue Shield of Iowa is rejecting my claim.
They also will not return my phone calls.
I am actually a licensed Iowa Insurance Agent, and know that they are totally in the wrong.
This is referred to as "Claims Control"
They claim it is a pre-existing condition. The definition of "pre-existing" is one that has been attended to in the six months prior to the effectiveness of a group policy. I had not visited or consulted for not six months, but rather for six years. There seems to have also been an inference that my problem may have been caused by a Chiropractor. That is not the case.
I was unable to continue the job position, I am now essentially unemployed, and insured on Cobra.
I have contacted the Insurance Commissioner's Office, where everyone was very polite, however, no comments or actions have been taken against my claim against Wellmark. I have not been helped.
Please note, I am also a Wellmark Independent Agent, so this situation is rather precarious. And this is certainly not the impeccably miserable level of policy holder service which I have thought went with a Wellmark policy.
I have shooting pains down the back of my leg, and Wellmark is not even returning my telephone calls.
Please... I really need immediate intercession. Thank you. Again, Fort Madison Hospital is ready for surgery on Monday August Fourth, Mr. Tom Amenell of FNCH has been told that they may provide service to me but there is no guarantee that Wellmark will honor the claim.
Thank you,
Tim Taffe
Iowa City
319 533 6869
Tim,
FYI – I spoke with Scott Potter at some length.in a nut shell, while he is getting a HCFA (CMS 1500) and a UB (CMS 1450) from Dr. Paul’s office, he does not think that will cause them to state the procedure will be covered. Essentially (this is in my words), Blue Cross wants to allow for something to turn up in their records search after the physician, hospital, radiologist and anesthetist have billed for their services that would allow or cause them to deny payment. This does not mean they will deny, just that they reserve the right to deny payment. I asked if the records search could be conducted prior to the procedure to answer the question to which he responded – No.
Thomas M. Amenell
Thomas M. Amenell, CPAM
Director Patient Financial Services
Fort Madison Community Hospital
5445 Avenue O
Fort Madison, Iowa 52627-0174
(p) 319-376-2155
(f) 319-376-2176
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