My husband received Blue Shield of CA insurance from his employer effective 04/01/06. Of 04/13/06 he went to the doctor for a growth on his neck that was effecting his breathing.in May he had surgery to have the goiter removed and a few days later we found out it was cancer. He is now going through treatment for Cancer. If that was not enough to have to deal with Blue Shield is denying all claims stating that this was a pre-existing condition. They sent me documentation to prove their case that proves ours.
What they sent states the following: "Pre-Existing Condition is defined as "an illness, injury or condition which existed during the 6 months prior to the enrollment 30 date of coverage if, during that time any medical advice, diagnosis, care or treatment was recommended or received from a licensed heath provider""
Since not medical attention was received until 4/13/06 and coverage was effective 4/1/06 then it is not a PEC according to what they just sent to me.
When I call I get told they are needing information from his doctors, yet they are unable to find out what they are needing. They tell me they have not received paperwork, until I tell them I have a letter from them stating they received it then they just happen to find it. They try to say that we sent our letters to the wrong office since we do not live in CA, but then we have to call and they say oops, our mistake your insurance is in CA.
They are playing games and trying to get out of paying for legitimate claims. We are paying our premiums, we have paid or co-pays and deductibles. It is not their turn to step up and do the right thing. We have enough to deal with right now I should not have to worry about whether or not they are going to do their job or not.
If you have a choice of insurance DO NOT CHOSE BLUE SHIELD OF CA. They will take your money but not pay your claims.
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