Blue Cross - Blue Shield Of North Carolina
Calling my appendectomy medically unnecessary, refusing to pay claim!

In August I found myself suffering from intense abdominal pains that did not subside within 24 hours of onset. I contacted my doctor in Ahwatukee (Phoenix, AZ) and after being examined I was told to go to the hospital immediately — the pains were accompanied by a 102 degree fever.

I received the best care possible from Chandler Hospital and after several tests were administered my appendix was removed later that evening. I had a smooth recovery - physically.

About one month later I started receiving bills for approximately $36K from Chandler Hospital. Surely, this had to be a mistake — after all, my husband and I had Blue Cross / Blue Shield of North Carolina insurance (we used to live in Virginia before the USAirways merger) — I contacted the hospital and asked that they not send me any more bills — and for 6 months they didn't.

June I started getting phone calls from the anaesthesiologist's billing department wanting approximately $700. I explained to them that my husband and I paid our emergency room fee and copay and that that should have been the end of it. So, at this point I've got bills coming from 2 sources because BC/BS denied the claim. Why? Chandler Hospital didn't obtain the necessary pre-surgery authorization.

Apparently, because my surgery took place late a night, it was too late on the East Coast for anyone to answer the phone and give the hospital authorization to perform my surgery. This happens all the time.infact, if you call Blue Cross / Blue Shield and get their recorded message they mention that "in life threatening emergencies pre-authorization is not required" Oh, really?

Perhaps we should have waited until the next morning giving my appendix time to rupture (possibly killing me) all so Chandler Hospital could do everything by the book and make the folks at Blue Cross happy.

At the hospital's urging I sent a written appeal to Blue Cross's Appeals Department and to their President and CEO. Within 2 weeks I received a letter from Kristie White in Appeals stating that Blue Cross / Blue Shield stood firm by its decision to deny the claim as my appeal came too late —after the 180 days. I didn't start receiving phone calls until June — that was well beyond the 180 day threshold.

Now it is October — my surgery was more than a year ago — I am getting bills in excess of $36,000 and threatening pre-collection notices all because Blue Cross / Blue Shield refuses to pay a claim for a medically necessary operation.

Upon receipt of Ms. White's letter I called her and asked that she send me written documentation that I am not financially liable for the charges — not only did she not return my call, she has yet to send me anything in the mail.
More on this later.

Company: Blue Cross - Blue Shield Of North Carolina
Country: USA
State: North Carolina
City: Durham
Site: www.bcbsnc.com

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