Hi moskrat,

I'm so sorry to hear about your insurance woes. I'd suggest that you actually consult with a lawyer who can read all of the paperwork to make sense out of the issue. It might be worth paying a couple hundred bucks to get clear on the issue...and you might even have a civil lawsuit on your hands. Something sounds amiss. And it might help to see the film "Sicko" to get yourself inspired.

Does that help?

Part A is for hosptial and Part B is for doctor visits, out patient surgery, etc.

I take it that you are still working, therefore your wife has coverage through your policy.

There is no logical reason why your policy would deny these claims because she HAS to have Medicare Part B.

It could be the way the claim was submitted in which it was flagged as other insurance involvement.

This issue with your insurance carriers can be resolved. There are several ways to do this. Either you can contact your employers HR dept and ask that they contact their carrier (BCBS) to get this resolved and / or contact the billing departments who is in charge of billing and have them review said claims that were submitted and ask that they contact BCBS as well and / or contact BCBS and speak with a supervisor for resolution that they, BCBS, should cover these charges as your wife does have Medicare coverage however it is only for Hospital stays (Part A) so in that case these other charges that are not related to inpatient stays are to be paid by BCBS.

I have dealt with BCBS thoughout the US and they can be a nightmare, however if you know how they operate can make it this somewhat easier. BC is a nightmare.

Keep notes on the number that you called or was transferred to, their name(s), date called and time, dept, control number (this identifies your claim within their system)...each claim will have it's own control number. So if you have to call back and they can't find the claim that was previously found...give them the control number. Works like a charm.

I might even suggest that you send a certified letter to your insurance carrier(s) as well as your state insurance commissioner.

From my own personal experience I did the above letters and it worked.

Don't give up and please be involved in your bills. You can always ask for your providers to audit any billing statements that you received. They can not refuse, that is your right.

I've been in this field for 20 years so I do know what I am speaking of.

Best of Luck and sorry to hear about your wife's diagnosis'. I too have MS and will have a breast bx on Monday due to two suspicious lumps.

May I ask ~ did your wife have chemo and / or radiation due to breast cancer and how did that affect her MS and the MS symptoms?

Best Wishes,

~Zig

Zig has it right except you might not need the attorney. Here's the deal with Claims. A claim is evaluated at the time it is presented. The claims department does not know you have other insurance. The forms you filled out at the Drs office tell them to bill to both, but the carriers do not know. All of a sudden, the insurance carriers find out that "oh, there is another insurance carrier". They pull back all their money and deny the claim. Why? It has to be proven "who is the first Payor". That carrier has to pay their portion, the send you an EOB (Explanation of Benefits Form) telling you how much they paid, what they wrote off, and what was denied. "YOU" then submit the bill AND the EOB to the secondary insurance carrier. You must keep notes, dates, people, etc. Start a spreadsheet and dates. Follow them up every two days. Within 90 days, you can be sent to the collection agency by the hospital. Call the hospital and tell them your wife is seriously ill and you cannot be sent to collections because it is harmful to her health to be put under this kind of stress. Tell the insurance carriers that they need to pay in a timely manner to avoid stress to your wife or you will hold them responsible. I would be happy to help you clear up this matter (at no cost to you) but I don't want my e-mail and phone number submitted to everyone world wide. I can't make any guarantees, but I used to do this for anyone and everyone without a fee to help people. If you submit this e-mail to the forum, I will give them permission to give you my e-mail address. You can touch base with me and we can go from there. In the subject line just put "Insurance help from the Forum"
I know BC/BS well. All insurance carriers will deny first and re-evaluate first and secondary insurance.

Don't sit and wait on this. You must be completely pro-active. Nobody will allow you to point the finger.

I have found more real information in these replies than I have found in 6 weeks of phone calls. Thank you so much.

I can't believe you would provide misleading information.

I did not mention the use of an attorney however I did mention Insurance Commisioner and each State has one. Claims dept would have other insurance information in their system if it was provided to them when insured was added. However if not provided by the insured and the billing dept submitted it on the claim then yes that might cause the claim to be flagged. OR if a dx raises a question to whether service provided was due to a third party.

When a patient is registered for services at a providers office / hospital the registrar will / should obtain all insurance information, primary / secondary / etc... So when primary processes the claim in question then the providers office will submit a claim to the secondary insurance carrier along with the primary eob and not the patient.

Have the patient follow up every two days & a spreadsheet? No, this is incorrect. My goodness if you call, let's say on Monday and "Sally" states that it will take 7 days to process, then you should allow at least 7 days. As long as the claim is still with the providers office then the follow up dept should be making those calls however if the patient wants to call then they have that right.

Sent to collections in 90 days: As long as the patient / insured / billing dept are communicating and process is being made then more than likely it would not be sent to collections. Think about it: Let's say the provider removes $70,000 from their A/R and sends it to a collection agency...wow, that would be a nice collection fee once BC pays. I would rather keep it on the A/R as long as process is being made and not give away unnecessary collection fees. And the old 70k on the a/r...it is explainable.

As far as holding them responsible for causing stress: Won't happen as when it comes down to this, claims are submitted as a courtsey and it is ultimately the patients responsibility for said bill (everyone signs a document at time of service). However as long as all parties are doing what needs to be done to get it resolved, it should work out.

ALL carriers will deny claims first: This is absolutely FALSE information, 100% false, false, false!

The information that I previously provided and the information that I have provided within this here post is accurate and correct.

~Zig

There is a Women's Health Rights Act sets certain laws regarding insurance being required to pay for breast cancer related treatment.

The initial denials might have been caused by the lack of clerification on what other coverage your wife had. Also, ask BCBS for a Nurse Case Manager if your wife doesn't already have one. They should act as your point person instead of you having to speak with a different costumer service rep each time you call.

Also, as someone else mentioned, speak to someone in your HR department.

Thank you all for the information. However, I am ignorant of a lot of these terms.
What is "A/R"
WHat is "HR"

Also, I am not working. I am 61 and am on SS disability due to Parkinson's.
My wife was a part time federal employee. She had to leave work due to a stroke to go along with her MS. Then Trigeminal neuralgia (both sides), now Cancer.
She draws about $400/month.
Insurance is not my strong point. I have done some reading and I have read where they will not tell you that you should have Medicare Part B to go along with your BCBS before they will pay, even though I'm paying BCBS $461 a month for my wife's coverage. I guess we should have received mental telepathic signals from out of the sky. Its in the manual if you already know it. But we never suspected it. If course, if I had known, I would have gladly acquired Part B for her but we didn't know. We don't have a lot of knowledgable friends either. I told a couple of retirees I used to work with that have the same policies we do what happened and they turned pale and rushed home to check their policies. I have Part B but I didn't ask for it, I just got a card in the mail. Glad someone was looking out for me.


Worried sick

HR: Human Resources

AR: Account Receivables