Blue Cross - Blue Shield Of North Carolina CALLING MY APPENDECTOMY MEDICALLY UNNECESSARY, REFUSING TO PAY CLAIM! Durham North Carolina

Nearing the end of October 2007 I received a phone call from the BC/BS of North Carolina's admin. After over a year of the hospital vs. insurance blame game BC/ BS decided to do the right thing and pay my claim. Of course, they acted like they were doing me a favor, but I am very happy that this has been resolved. This turned my $36K bill into a $500 bill.
As for the jerk who posted the rebuttal -- the insurance accused the hospital of going about things the wrong way -- not me. If the United States healthcare system wasn't flawed Michael Moore wouldn't have made the movie "Sicko".

I'll try to offer some suggestions here in follow up postings but have some questions also, depending on how this first one is answered:

1. When did you first receive an EOB (Explanation of Benefits) from BC/BS? Typically you should have received one within 1 or 2 billing cycles, 30-60 days, after the hospital submitted a claim. The EOB would detail the charges submitted by the hospital and codes for denial. Did you get one of these at all? Even though you told the hospital not to contact you about the charges this would not have kept BC/BS sending you an EOB.

If you did receive an EOB like this then BC/BS may be saying that since you didn't appeal the denial within 180 days that the case is closed. It's going to make it more difficult to fight this if so.

Let us know.

I'll try to offer some suggestions here in follow up postings but have some questions also, depending on how this first one is answered:

1. When did you first receive an EOB (Explanation of Benefits) from BC/BS? Typically you should have received one within 1 or 2 billing cycles, 30-60 days, after the hospital submitted a claim. The EOB would detail the charges submitted by the hospital and codes for denial. Did you get one of these at all? Even though you told the hospital not to contact you about the charges this would not have kept BC/BS sending you an EOB.

If you did receive an EOB like this then BC/BS may be saying that since you didn't appeal the denial within 180 days that the case is closed. It's going to make it more difficult to fight this if so.

Let us know.

I'll try to offer some suggestions here in follow up postings but have some questions also, depending on how this first one is answered:

1. When did you first receive an EOB (Explanation of Benefits) from BC/BS? Typically you should have received one within 1 or 2 billing cycles, 30-60 days, after the hospital submitted a claim. The EOB would detail the charges submitted by the hospital and codes for denial. Did you get one of these at all? Even though you told the hospital not to contact you about the charges this would not have kept BC/BS sending you an EOB.

If you did receive an EOB like this then BC/BS may be saying that since you didn't appeal the denial within 180 days that the case is closed. It's going to make it more difficult to fight this if so.

Let us know.

I'll try to offer some suggestions here in follow up postings but have some questions also, depending on how this first one is answered:

1. When did you first receive an EOB (Explanation of Benefits) from BC/BS? Typically you should have received one within 1 or 2 billing cycles, 30-60 days, after the hospital submitted a claim. The EOB would detail the charges submitted by the hospital and codes for denial. Did you get one of these at all? Even though you told the hospital not to contact you about the charges this would not have kept BC/BS sending you an EOB.

If you did receive an EOB like this then BC/BS may be saying that since you didn't appeal the denial within 180 days that the case is closed. It's going to make it more difficult to fight this if so.

Let us know.

With ANY insurance provider, you MUST get pre-approval before having a surgery. And yes, there are people available 24/7 to answer the phone, as in the case of emergency surgeries. Just assuming that it is too late to call the east coast is a ridiculuous assumption on your part. It sounds like you are trying to use that as an excuse to get out of paying the bill. Insurance companies have rules for EVERYONE to follow, and no, you are not exempt from the rules.