Blue Cross & Blue Shield CareFirst

I have gone threw so much with this company. My first request for approval was denied. And since then I have done five appeals with them and all have been denied. What gets me the most is that everytime I spoke with anyone in their office. The agent or person reading my case would tell me that it's and exsulsion in the contract and that it is not covered. I have asked them to look at all the medical problems I have and get this you will love it. They would tell me they don't need to look at that all they need to do is look at the contract. I just don't get how they can do that. And I bet ya the person/s that I have spoken with are these thin tiny girls. Hey if you have any information how I can get them to read my medical records. Please send me any information. At this point I am going to be a self pay and it taking some time to get the money together but I am going to get the surgery done. I would rather have my health insurance pay for it seeing that is what I am paying them for, service.

Donna, I have been fighting BC/BS CareFirst but I found it is not the insurance company I had to fight. It was the employer who bought the policy in the first place. My husband works with Metro. They state they have an exclusion - I have never seen it in writing. They will not give me a final denial yet - they keep saying they need to research more. This has gone on since 11/02. Who is your employer? Allison

Hi Donna: What you need to do is talk to the Human Resource dept at work. The employer gets a copy of a contract from Blue Cross when they sign on with them. It's a HUGE legal document but if you skim thru you will find exclusions. The reason there are exclusions has nothing to do with you personally. When the employer negotiates the contract with the insurance company many factors come into play, like size of the organization, whether they will pay 100% of the employees premium or not, and what they can afford to offer. Health insurance costs have risen about 46% for some employers in this economy! It is dreadful. So if they can't afford the big fancy policy for their employees they may have to exclude certain items. It's like signing up for cable TV. You get your basic channels but it'll cost you more for the movies. But double check. Get your human resource person to check with Blue cross directly. Something might be able to be worked out. ALSO - it could be your medical group that is the problem. They also have criteria they go by. Ask for their criteria.