People might want to double check their policies when sending their child to college. Speak with an agent, get their name and side of the story before they deny you coverage for out-of-network visits that you supposedly have.
My father worked hard for his company to be sure he could get the best insurance possible, and the answer was Blue Cross / Blue Shield and he paid handsomely for it. Blue cross was nice enough to cover me while I was still enrolled in college, a college that happened to be out of their coverage area. Now, there is of course Blue Shield of Western New York and one would think that this nationwide insurance giant's network would be just as big but I recently found out that they purposely break it into these little regional subdivisions for the sole purpose of having a in-network and an out-of-network division so they can charge more for one over the other.
So, he paid for their plan with out-of-network coverage and I guess there is a $500 deductible on that. I had gone to specialists in never had any problems with them paying for it, apparently the deductible had been met even though the person on the phone who was looking at claims history on the screen in front of her couldn't tell me whether or not that was the case. I was about to finish college and thereby be loosing coverage so I decided to go to the dentist since I hadn't been in 2 years (6 hour dirve is a lot for a cleaning). It was a regular cleaning and since it was a new dentist and i didn't have any x-rays on file, I had them do that too, total about $200. I had called BSENY, they said x-rays are covered, 1 every 5 years or something so it was good.
Then my dentist tells me BSENY says I'm not even a member. So I get that straightened out, and now BSENY says, not covered for out-of-network, apparently there's a difference between the dental and health policies, and I get out-of-network health but not out-of-network dental. I said, well how am I supposed to go to the dentist while at college, the whole reason I'm even allowed on the policy is because I'm in college but I can't go to a dentist anywhere near my college, I have to drive 6 hours for a cleaning? But, I guess it is in the policy. They said I could appeal on the form on back of the denial letter, of course they never sent a denial letter, they just never paid the dentist so I had to do it. Whatever, I was over it.
Then, I got this allergic rash thing, like eczema, and decided this itching and burning around my eyes and elbows was unbareable and I'd soon be loosing my ability to go the doctor (which I rarely did anyway) and since I had just found out that I did in fact have out-of-network doctor visits, I would see someone about it. But after having been tricked about the dental, I decide to call first and check... Good thing... Why can't I see someone? One person said, I wasn't signed up as a person under my father who was allowed out-of-network, some type of waiver thing, but I will be covered, I just need to send in this paperwork, which will take 2 weeks to get to me and another 30 day waiting period. I said that's absurd, I've been to the doctor before. They said this changed when the policy was renewed in '04. I went to the doctor in '06. Only after they varified this did they tell me I hadn't met the deductible.
I had to do a work-around and get an urgent care referral from my primary back home, which was another nightmare to coordinate, just so I could go to the doctor out here. Anyway, I wasn't ripped-off in the common sense of the term, but they were throwing every excuse at me to try and deny me coverage and delay treatment until I was off the policy. I thought you should be warned that out-of-network coverage doesn't necessarily mean that all the time, read carefully and don't believe what the agent tells you you have, there's always an asterisk... And be warned that if you're nearing the end of your policy, they will give you the run-around to delay your treatment so long that you're no longer covered. They will frustrate you until you give up and they hope you can afford the bill more than you can afford the attorney or the time to deal with it.
I can't begin to imagine what people with serious diseases like Heart Disease and Cancer being denied are going through, but I thought I'd let people know, its not just the expensive diseases that they screw you on, they will try and screw you even if you're young and relatively healthy over a single doctors visit, or a routine cleaning. If you already have, or are thinking of getting BS/BC, just be sure you know your exact terms, or try to find something better.
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