Complaint Review: Blue Cross/Blue Shield of Minnesota - Nationwide
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- Author Not Confirmed
- Blue Cross/Blue Shield of Minnesota Nationwide USA
- Phone: 719-244-3544
- Web:
- Category: Health Insurance
Blue Cross/Blue Shield of Minnesota Bad Faith and Breach of contact rights Minnesota Nationwide
*General Comment: Fusion....
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My wife was denied essential and necessary treatment for a lower fusion surgery by Blue Cross and Blue Shield of Minnesota. Back in september of 2014 my wife had fusion surgery in her cervical area and was also told at that time that she would also need fusion surgery for her lower back as well. In december of 2014 I lost my job and my employer (travelers insurance) paid for health insurance for the remainder of the month (december 2014). On Dec. 9th, my wife's doctor submitted urgent/needed paperwork for surgery. The doctor, myself and my wife waited 10 days for the answer to come. we were told it was "denied". "We" (the doctors office, myself and my wife) asked why and they refused to give us an answer as to why. We asked for a case manager or a supervisor and was denied that information. We were told "we" had 30 days in which to appeal the decision. I strongly believe that because it was the end of month (I recieved the information on Dec 23rd that I was denied, (after I called them, they did not bother calling me.) and I am without insurance after the 1st of the month in January that they know I did not have insurance with them after the end of the month that they denied essential, needed, urgent surgery. I believe that they are in violation of breach of contact with me and my wife as well as having all the elements of Bad Faith. They should be sued.
This report was posted on Ripoff Report on 12/23/2014 10:23 AM and is a permanent record located here: https://www.ripoffreport.com/reports/blue-crossblue-shield-of-minnesota/nationwide/blue-crossblue-shield-of-minnesota-bad-faith-and-breach-of-contact-rights-minnesota-na-1197281. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year. Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report. READ: Foreign websites steal our content
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#1 General Comment
Fusion....
AUTHOR: Tyg - ()
SUBMITTED: Tuesday, December 23, 2014
See the problem is that the operation your wife needs is well over 150k. That doesn't include the extras like meds, room, after home care. Why YOU would expect that are going to drop 150k+ on a person who is not staying with them. Just because YOUR doctor thinks its needed, doesn't mean THEY have to pay for it. She has already had one operation this year. If you wish her to have this operation YOU will need to continue paying the insurance until she becomes available again. Insurance is NOT a bank account, but it kinda is in a way. Think about it for just a moment. EXACTLY how much do you pay into your insurance EVERY YEAR?? If you didn't pay over 150k in this year, guess what, THEY are going to deny you. As someone who has had to have the very surgery that SHE needs I can tell you it IS expensive. SO odds are you were denied because they have already paid for one operation this year and are not willing to pay for another. Its NOT a scam. Insurance is to cover those expenses, but they can only pay out so much PER customer. Some claims MUST be denied. Face it, your doctor IS NOT paying for the surgery. He is getting paid to DO said surgery. While Im sure your wife is uncomfortable to say the least, you have to understand THIER position BECAUSE they are the ones paying for it. YOU and your wife ARE NOT the only customers who are having proceedures denied. Its also the end of the year and they are trying to close out the year profitable. You don't make profit by paying out on EVERY claim that comes through. And face it, THAT is the ultimate goal for THEM. NOT to be the wallet that YOU have paid into for years, but to make money for their stock holders. It is the way of business. I would try and carry your insurance another month or two and see if you get a favorable result AFTER the new year starts. Im sorry you are in this boat but YOU were removed and THEY DO NOT have to authorize another surgery for your wife when YOU are NOT really a customer. And really a 150K+ payout to someone who IS NOT a policy holder any longer does not make good business sense.
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