A Story to Make You Laugh and Cry
I received a call from a young man who was asking about an insurance problem for his father. He told me last year he had gotten insurance with Blue Cross NJ. His father has high blood pressure which he put on the application. He was enrolled and covered for all illness at the onset. One month later, he was having vision problems and went to the eye doctor. The eye doctor sent him immediately to the ER where a brain tumor was diagnosed. Successful surgery was done the next day. He recovered well with no further problems. A year later, a bill was received from the hospital stating the insurance was not paying for treatment due to pre existing condition. The insurance is saying high blood pressure is a pre existing condition for a brain tumor. Needless to say, the son was in a panic.
Here is where we have crossed into the twilight zone. There is no data supporting this premise. What we know is, high blood pressure may be a result of a brain tumor but not the opposite. The father had high blood pressure for a long time. If this is the premise used by insurance , high blood pressure may be the cause of all things medical. Dare I say lucky for us, pre existing conditions may be history very soon. Here is a prime example of the insurance companies making decisions not based in science but dollar value.
Unfortunately, it will now take time and effort to get the insurance company to reverse on appeal. There is so much research refuting this decision. I do think it is a decision that will need to go to an external appeal. In the interim, I have advised the family to gather all the medical notes, letters from doctors and begin the appeal process. When in a situation like this, I advise people to speak with all involved providers, let them know you are appealing and sometimes it is necessary to make a small payment on the bill. As long as it is in the computer files of the billing office, you won't go to collections. Billing offices like to know you are trying to work it out. I also advise to get the financial aid papers filled out as a back up.
So hold on everybody. The ride to implementation of healthcare reform is going to continue to be bumpy.
Posted by HealthCare Whisperer at 3/26/2010 9:27 AM 
Categories: insurance, pre existing conditions, brain tumor, high blood pressure
Tags: medical insurance brain tumor pre existing conditions
Categories: insurance, pre existing conditions, brain tumor, high blood pressure
Tags: medical insurance brain tumor pre existing conditions
Comments