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They were the insurance company of my mom and dad's pensions. For my dad's medical expenses in the Philippines, they hardly reimbursed expenses, maybe as low as a 5% reimbursement. So we took their $495 monthly charge off my dad's pension, and we pay medical bills outright in the Philippines. But Philippines has cheap medical costs, as the people there are poor. My cousin had surgury and it only cost 100,000 pesos. I had two cracked teeth and a dentist filled them up for 700 pesos total [ $15.73 !].
Next, my mom died of pancreatic cancer. But most of her medical bills were paid by Medicare. Blue Cross Ble Shield wouldn't pay anything for her $2800 CAT Scan. MD Anderson doesn't get reimbursed by Blue Cross Blue Shield.
So if you got Blue Cross Blue SHeild, tell us how it has treated you! I think it's crap insurance just sucking premiums for profits.
Next, my mom died of pancreatic cancer. But most of her medical bills were paid by Medicare. Blue Cross Ble Shield wouldn't pay anything for her $2800 CAT Scan. MD Anderson doesn't get reimbursed by Blue Cross Blue Shield.
No one here has a problem with a BCBS Medigap paying its 20% share of Medicare-approved charges.
Following response assumes your mother did not have a BCBS Medicare Advantage plan but, instead, had a BCBS supplement (Medigap) to Medicare.
If Medicare pays its 80% for the CAT scan, BCBS Medigap is required to pay the remaining 20%.
Because nothing was paid for the CAT scan, that means the CAT scan was NOT a Medicare-approved charge. Therefore, BCBS had no responsibility for that CAT scan, either.
Some Medigap supplements will pay preventive charges not covered by Medicare - but those charges must be coded preventive. If they are diagnostic, those plans won't pay either.
Advantage plans are a whole 'nother kettle of fish, and these plans can and do stall or refuse payment for certain services.
Suggest you Google "Medicare CAT Scans" - there is a reason this charge wasn't covered by Medicare. BCBS isn't your problem. Lack of Medicare approval for the CAT scan probably is.
Last edited by Ariadne22; 04-20-2014 at 10:12 PM..
I love my BCBS Insurance in MN., although I realize their service isnt as good everywhere by the complaints I see on the internet. I wish I could still afford it when I go on Medicare in June, but I am going to a cheaper Medicare Advantage Plan instead. If I have major problems with them, I will go back to BCBS as soon as I can.
- there is a reason this charge wasn't covered by Medicare. BCBS isn't your problem. Lack of Medicare approval for the CAT scan probably is.
Or, there's the possibility that this particular hospital doesn't process Medicare claims and the patient had to do the submitting herself.
This could be a rant that's based on inadequate information.
Or, there's the possibility that this particular hospital doesn't process Medicare claims and the patient had to do the submitting herself.
This could be a rant that's based on inadequate information.
Anderson will process claims for Original Medicare and many other plans:
MD Anderson also accepts regular BCBS, but NOT the BCBS MA plan:
Quote:
Blue Cross Blue Shield of TexasHMO, PPO, POS, IndemnityBlue Choice PPO, Blue Choice PPO Marketplace Plans (Blue Choice Gold PPO, Blue Choice Silver PPO, Blue Choice Bronze PPO); Multi-State Marketplace Plans (BCBS Premier 1, BCBS Premier 2, BCBS Solution 3, BCBS Solution 4, BCBS Basic 5); Blue Choice Plus POS; HMO Blue Texas; Best Choice PPO; EPO; Blue Edge; Traditional Indemnity
Note: MD Anderson is not contracted with the Blue Advantage HMO Marketplace plan.
So, if OP's mother had a BCBS MA, none of her charges would have been paid.
But, since he says Medicare paid for everything, it must have been a BCBS Medigap.
Ergo, charge was not approved by Medicare - probably because it exceeded the number of times Medicare pays for a CAT scan with a certain time frame - a common Medicare limitation - and/or, given mother's terminal condition, scan was not considered medically necessary.
Until OP clarifies further, for now we are speculating.
Last edited by Ariadne22; 04-22-2014 at 01:22 PM..
BCBS has been my supplement for Medicare and has done everything they are supposed to do. They have been great.
Yes. As a Medigap, there should be no problem with BCBS. No one ever complains about a Medigap, no matter the insurer, because the Medigaps are required to pay the 20% Medicare doesn't. Medigaps do not have any nonpayment rights when it comes to Medicare-approved charges - unless these charges are specifically an exclusion in that policy.
I don't know what specific BCBS plan was under the Chicago Teacher's Pension Plan. But the original $2800 Cat Scan at Presence Health was necessary for the diagnosis of pancreatic cancer.
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