BCBS/Insurance Commisioner Office

I was told by BCBS of Delaware that CHiRAS is out of network after Dec.15. There are no other physicians in Delaware that are in network under the EPO. BCBS said I would have to see a Dr Katz in PA for follow up and band adjustments. Spoke with Dr Irgue today, he is more than willing to resume talks with BCBS. He asked if I would contact the Insurance Commisioners Office and express my concerns to them, what I've been told by BCBS and see what they can do. Perhaps the Commisioners office can assist in arranging open talks with BCBS. So I am asking everyone who currently has any type of BCBS to contact the Insurance Commisioner's Office http://www.state.de.us/inscom/default.shtml or 302-674-7300 or e-mail them at [email protected] This is the time of year allot of employers are having their open enrollment period, make your benefits department aware of the situation also. I choose CHiRAS for a number of reasons, the physicians at this practice have a very high rate of success. they care about their patients. The entire practice and staff treat their patients with respect and understanding. Sorry to rant so, I'm concerned and frankly scared because if they are no longer in network, I don't know where I will turn. My only other option is to switch insurance companies or switch my coverage from a EPO to a PPO which will cost me double what my insurance cost is now and require me to pay 30% of the charge for an office visit out of pocket. There are a lot of people who don't have the option to change insurance carriers. Please make you feeling know to CHiRAS, BCBS and the Insurance Commissioner...Thanks Linda

I also spoke to BC/BS today and was assured that can STILL go to CHRIAS and Christiana (atleast for now) since I called asking why the last 2 claims that CHRIAS sent in to them were denied. It appears that someone coded the claims wrong(imagine that) and I asked for a resubmittion of these claims. I stated to the insurance that I have a follow up appt with Dr Irgau next week and would it be paid. No problems but then again I have PPO and can pretty much go anywhere. I also made an appt at PMRI for a followup in Jan /07 with them knowing I have BC/BS and they said I can still come there. Maybe it depends on who we talk to or whom the Insurance is Administered under/Employer. Gosh being a Diabetic,Weightloss Surgery Patient, and a Healthcare Professional I know I better be able to be able to obtain Quality Healthcare in my local area.......

Thank you for responding, how do you find your out of pocket expenses with BCBS's PPO. My employer is Astrazeneca and I'll be speaking with them and reviewing my health care options tomorrow......Linda

Hi Linda, I find that the BC/BS PPO is terrific for my needs. I have the High Option plan thru my employer which is a $30.00 co-pay for a Specialist. I have not found any physicians and or facilities in the Tri-state region that is NOT in network. I work in the medical field for one of the top world leaders in Medical Equipment/Instumentation. Healthcare is one of the top concerns for most Americans as well as Employees. Look into what your Employer has to offer since year end is Insurance time...... Take care...Sharon

Well, I decided to write to the commissioner. Here is the letter that I sent. While I am only one voice, I tried. I do feel that the more people that contact them, the better leg we will have to stand on. I am writing in lieu of a tremendous concern of which I presently have regarding a conflict between BCBS of DE and Christiana Institute of Advanced Surgery. I am public school educator and as an employee of the state, have elected to use BC/BS as my health care provider. In September of 2005, I had Gastric Banding surgery. The physicians of Christiana Institute of Advanced Surgery (CHRIAS) who performed my surgery are experts in their field and are the epitome of professionalism. The physicians are top-notch and are well trained in their field of weight loss surgery. CHRIAS is affiliated with Christiana Hospital, St. Francis Hospital and Wilmington Hospital. The office is located in Newark, DE. Because the gastric band is merely a tool, it requires adjustments, replacements of leaky ports, etc. With the gastric band, a patient requires a saline fill into a port in order tighten the band around the stomach, thus enhancing weight loss. A fill is not a matter of choice, it is a necessity of which to assure the success of the operation. BC/BS of DE is no longer going to accept medical claims from CHRIAS after 12/15/06. As a patient who has yet to reach her weight loss goal, this is of great concern to me. I am sure I am safe in speaking for other patients with BCBS/DE in the same situation. This is a pressing, serious issue that needs to be addressed immediately. Time is of essence. CHRIAS is willing to work with BCBS/DE and has tried to come to some sort of agreement in terms of payments countless times, however, negoations have not been fruitful. What am I (we) to do after December 15, 2006? Yes, there is always the option of paying out of network costs, but the cost to do so is extremely high and is not within my realm of affordability. I feel as if I am caught between a rock and a hard place. I had this operation to assist me with weight loss, yet now that CHRIAS will no longer be considered "in network" what am I (we) left to do in terms of receiving medical care? To me, this is incomprehensible and unacceptable. If you would look into this matter and research it for me, I would be forever indebted. Thank you in advance for you assistance to this matter and I look forward to hearing from you soon

Carla, Would you mind if I took parts of you letter to use in a letter I would also like to send to BC/BS? You took some of my thoughts and used them so wonderfully. Thanks, Ellen

I'd be flattered. There is power in numbers. Please note that I do have a typo...........negotiations is the correct spelling.

Below is the response I received today: Our office has received and reviewed your correspondence. From the information you provided, it appears that the following agency has jurisdiction over your complaint as the contract is a self funded, ERISA policy regulated under federal law. Office of Management and Budget Attention: Brenda Lakeman, Statewide Benefits Manager 655 S. Bay Road, Suite #202 Dover, DE 19901 Phone: 302-739-8331 Your correspondence has been forwarded to that office for its review. We anticipate its staff will respond once an assessment has been made of your complaint. Please direct any further inquiries about this matter to the office and address listed above.