Question:
Seeking Those With BCBS Traditional of Michigan who went through BTC

I just got my explanation of Benefits statement from BCBS today! Oh my God I thought I was going to die! My amount charged to BCBS was 48,460.61, and they only payed 12,181!!! They denied the anesthesia bill and the bill for the consult saying you are responsible for the bill because your contract excludes coverage for these services. Do these clowns at BCBS expect me to have surgery without anesthesia?? Im also wondering If Im going to get a 36,000 bill cause BCBS only decided to pay 12,000? The surgeon's bill was 5400 and they paid him 1488 but under that it said something about the provider of this service accepting this amount as full reimbursment. It didnt say anything about that for the 48,000 bill. This just really irks me, here I went through the surgery cause BTC said this was one of the best insurances to pay for this and now this happens. Anyone with this same insurance in Mich go through this? My husband has a good job, but we cannot afford to pay a 36,000 bill. Oh I forgot to add, we have our Blue Cross through Ford Motor CO. HELP!!!! Any advice would be appreciated!!! Thanks!    — Kris T. (posted on March 26, 2003)

March 26, 2003
I did not go through btc but I do have bcbs of Michigan and the originally denied all of my preop testing. I immediatly sent them an appeal letter stating that I felt they were in error by not covering these costs, after all who in their right mind would have this surgery done with out preop testing. They agreed and covered all the tests. Some times you just have to let them know that you are paying attention. I believe they have thirty days to respond to your appeal. lap RNY 276/203/150
   — charlotte W.

March 26, 2003
Kris, I have trad. bc/bs of Mich. I got my surgery in Flint. I was gonna go through the BTC originally though. I would call them because they have a pre-approval dept. that should have taken care of this ahead of time.All of my surgery 38,000 was paid except a co-pay of 1,025.00. They also paid the docs consult except for co-pay.Again I would go back to BTC maybe they coded your procedures wrong or something.
   — Elizabeth C.

March 26, 2003
I didn't have BTC but I do have MI trad BCBS and had surgery Dec. 31. I am getting the same letters. I think the hospital bill was about 22,500 and BC paid 12,000. This hospital contracts with BC and has to accept it as payment in full. I wonder why BTC's bill is so much more and do they accept BC payment as payment in full. You need to call their billing dept and see. BC also didn't pay for the preop testing but it was only a couple of blood tests and under $100 and I haven't gotten a bill for that from the hospital. They also rejected one of the anesthesia bills as not a covered service. Did you have an epidual for pain control, I did and am hoping that this isn't why they rejected that bill. They were also 2 other bills for anesthesia which they did pay. I am wondering why there are so many bills for anesthesia for the same day. If I actually get a bill myself for it I will be checking into it. I also had to pay an internist who saw me while in the hospital about $30 that insurance didn't pay. I had to give my surgeon $3000 up front because he didn't participate in BC and didn't accept their payment as payment in full. His office also billed BC for 3 assistants fees, how many assistants do you need, but I haven't gotten a bill for that even though BC only paid 1 assistants fee. But having given them $3000 I don't think I'll be paying them anything else. Bad part of that is that they started accepting BC as payment in full as of Jan 1 and no one told me so had I waited one day I wouldn't have had to pay that $3000. I also had to pay $200 for my psych consult and $125 for the intial consultation fee. It sounds like BC is pretty much paying the same for you and me. I don't know how long it will take to get this figured out and I haven't gotten any bills personally for the hospital or anesthesia yet. If I do I don't think it is really our responsibility so I will be dealing with it then.
   — sandy L.