I'm an employee of Ionex Telecommunications with BC/BS insurance provided by my employer. My husband had an accident covered by major medical (dental) and needed dental work. He went to a dentist within the prescribed 48 hours.
BC/BS advised the first three dentists seen by my husband that he had no coverage (medical/dental, exhibits available). The fourth dentist did the work but we were required to pay at the time services were rendered, which we did (exhibit available). Blue Cross Blue Shield refuses to re-imburse us. The accident occurred Feb 8.
We have been plauged with BC/BS using a purported Fraud Division looking into our situation. This fraud division was basically designed to intimidate people so bcbs would not have to pay the claim.
My husband lost two months pay due to suspension by his employer until his employer was able to determine whether he was at fault which was implied by BCBS's so called fraud department or actions unbecoming an officer.
We have sought legal help and this so called fraud division would make the attorneys run. Even with all the supporting documentation, doctor stating he saw the patient within the prescribed amount of time, that yes there was damage and now all of a sudden bcbs admits he did have coverage but they are still denying the claim.
I could not believe that some attorneys we contacted wanted $20,000 up front in order for me to collect the $20,000 dollars owed me by bcbs. Where's the benefit of that?
One attorney said, yes I will represent you, but don't tell anyone especially bcbs that I represent you, pay me $5,000 in advance and once my husband and I have exhausted everything to do that we know of, then he would possibly step in to see what he could do.
At the time I filed with BC/BS, I had learned that they were only a URO in the state of Kansas (which is the location of the office where I work at that time) and Ionex was self insured
according to Tony Salazar of the Kansas Insurance Commission.
I have since learned from the Texas Insurance Commission that Ionex was not self insured and that BCBS was our insurance provider. They just retained the position of who they would and who they would not pay.
Since I blew the whistle to the Texas Insurance Commission, my credit file has been accessed and derogatory remarks have been placed on my credit file.
I'm still able to say that I'm an employee of Ionex but without benefits. Since placing this ripoff on your site I have been notified today that the new medical/dental insurance company that I receive benefits from has been forwarned about the possibility of fraud in depth.
This was done so my husband could not receive any form of dental care. Over the past 18 months everything that Ionex/bcbs has asked for has been given. Dr from the inception states he appeared on time, reported but because bcbs could not confirm insurance no work was done.
After months of bcbs denial of coverage a faint recollection appeared subject to proof of reporting within 48 hours of the accident. Once that was done, each and every item that was requested was basically used as an avenue of deceit and deception in order for the required two years to pass preventing any recourse on our part.
We are still seeking legal help on a 50% contingency basis.
Lillian
Waukomis, Oklahoma
0 comments