BC/BS Update and CRIAS

Ok, I can not allow things to die. Call me obsessive-compulsive or what have you, but I have now received more information via the insurance commissioner. I contacted her, yet again, to discuss the continuing saga. That is, post-op patients and where we are to go for care. Here is the response that I received from her. On an additional note, I was told the same thing last week from a BC/BS representative, so the story remains consistent. As per the commissioner's office: I have just been informed that if any member has had surgery by CHRIAS and needs post op care only it can be provided by CHRIAS. You can go and it will be considered as in network and you then would be responsible only for the copay. The provider is to bill Blue Cross and they are aware of this arrangement. Please contact the provider about this arrangement.

Carla, That is great news! It will be interesting to see if this really happens. I had an appointment in Dec. which I cancelled because I could not afford the $125.00. I am now scheduled for February. We will see what happens. Thanks for keeping us updated. Ellen

Hey Carla, Thanks for the update...That is great news.....Hopefully everyone does their part and the patients will be the one who makes out.....Dave

FYI: What happend to me this past month was the emergency 2 admissions before 12/15/06 I was admitted to Christiana under the care of the CHRIAS Surgeons and I have BC/BS PPO. For the Emergency Admission under the care os the same surgeons on 12/22/06 I had to be admitted to St Francis (even tho BC/BS had already paid my first two admissions to Christiana). My follow up care with the Diabetic doctor is ummmmm thru Christiana (I actually had to go in person the PMRI) to explain why I wasnt admitted to Christiana even tho I dont know why and can Dr Lenhard try to get my Labs I had as an in-patient in St Francis and if not I will have to have even MORE Labs done. I am going to ask Dr Irgau tomorrow about all of this. I know not everyone has the problems like me but gosh I like others want to know what to do when you have insurance.........

This is the response I got from BCBS, what your saying is follow up care at Chrias is now covered, it that correct. or do I still have to have them submit a letter of necessity? I am so glad you kept on top of this, we all have to, and maybe as patients we will come out on the winning side for a change. Thanks .....Linda This email is in response to your recent Internet inquiry. We welcome the opportunity to serve you. Thank you, Mrs. Trainor for your inquiry. Please have Dr. Irgue send a letter of medical necessity for using an out-of-network provider for review. You can have the provider send this to my attention and then it will be forward to the Medical Director for review. This will be considered on a case by case basis. Again, we appreciate the opportunity to serve you. If you require further assistance, please contact our website at www.bcbsde.com Sincerely, T. Mack Customer Service Representative

OK, I am confused. I had a lap band follow up appt for 1/4/07. At this appt I was told that Chrias was no longer in Network and my visit would cost $125.00. Of course I had to cancel my appt/fill and make an appt to see a dr in pa who is in network, so what are you saying? are the dr's back in network or what?. denise