BC BS of Tennessee Blues

[Soundy]

I just learned today that my husband's work place is switching insurance...we are
on CIGNA and although I cannot get them to approve BAHA they have paid well on
everything after w few paper work glitches were cleared up...

I was sent a questionnaire and a phone number to call... I was singles out in our family as a
"potential liability" ... in other words I may cost them money... I talked to the woman at BC BS
and was told that my AN would put me in pre-existing status for BAHA and further MRIs and
visits concerning the AN would not be covered for a year under the new plan ... this sounds
like light years to me ... I can deal without BAHA...what I can't deal with is the headaches and
no coverage for doctor visits... was also told that the deafness would probably not be covered
if not addressed before switch over... but I can take out a supplemental policy on myself to be covered
but it will still not pick up til their waiting period is over...also told I can appeal this

Cover sheet explaining the cost of new coverage and changes in co-pays said it would be a seamless
transitions...I see nothing seamless about this... change will take effect July 1st so gut says fight fight fight to
get BAHA pushed through under CIGNA... crossing eyes on that  (if I cross fingers I can't type) ...

Any ideas from anyone who may have been in a situation of losing insurance??? where to start fighting?
I don't know what I want to ask... just a bit peeved and depressed over the whole mess

[sgerrard]

It seems to me that if the company switches insurance, existing conditions in the process of being treated must continue to be treated under the new plan. They can't tell someone in the middle of recovery that they will have to put it on hold for a year. This isn't an optional change, is it?

What if the company changes insurance provider every year? Does that mean that no one ever gets any treatment, because each insurer has a one year waiting period? It seems to me that if you get to the bottom of it, with the HR department at the company,and the new and old insurance companies, there will be some provision for completing treatment.

Hope it works out.

Steve

[Soundy]

That is what I thought when told the transition would be seamless ...that what
was already being treated would continue to be taken care of...but then told
all the other stuff by BC BS people

HR person's husband had open heart surgery about 6 months ago and he is on
her plan and is going through same thing... she is a fighter... several of us with
ongoing health issues , met today with her and I feel alot better about it all... not that
I glad her husband is in bad health but his case will help us all as she fights to keep us
covered seamless as promised...

Still going to continue on getting BAHA paid for just incase... CIGNA will pay for implantation
but not hardware unless I can prove it necesary...which so far the reasons I have stated as
needing it have not satisfied them...trying to get a letter of necessity from doctor...

People around me thought ... OK she had the AN removed and it is over now... can't make them
understand that surgery was just the beginning of a battle... been fighting someone
(usually insurance ) ever since surgery... tired but feeling better ...

keeping eyes crossed that we win this

[jerseygirl]

Soundy,

Don't give up! Insurance is there to cover you when you are sick, otherwise it is not needed! BCBS is known to do this. I just read about the California insurance companies who do exactly the same thing. The governor's office got involved and many people are reinstated. I am not even sure it is legal if it the group insurance. Hope to hear good news soon.

                         Eve

[leapyrtwins]

Soundy -

don't give up on getting the BAHA approved.  Lots of insurance companies turn down the first request for it; usually they change their ruling on the second request.

Good luck,

Jan

[Soundy]

Cigna still refuses BAHA but since we switch to BCBS as of June 30 I am giving up there and going to
start working on BCBS...

They are going to continue covering me as Cigna did and not call me pre-existing ... one lady I talked to from
BCBS said they send out those letters and it saves them millions as most people go Oh well and don't
fight it ...  ... just like I had decided they were jerking us around to see what we would do and if they could
worm out of paying a few bills ...

Big changes ... we no longer have deductible and have to pay for in full for office visits and any medicines  til we
have paid out $1200 per family before insurance kicks in and pays anything ... then it is 80/20 til $2000 is paid out then
100% of covered charges... their year runs Jan 1 til Dec 31 ... I have to get a letter from Cigna saying my deductibles
and out of pockets have been met and BCBS is going to give me credit for it through Dec. even though Cigna's
year for us ends on June 30th ... so I will have from July 1 til Dec to get BAHA approved and done

Husbands place of work is going to give each family $1200 this first year with a debit card to use at offices ,hospitals
and drug stores... we are putting in $100 a month to make sure it is there as needed ... as we use what company
has put in , we will be adding to it and not really miss anything since premiums are $108 less per month than they
were with Cigna...

Over  all satisified with what has been set up... it is a lot better than the original We are not paying for anything
to do with your head   letter I got

[leapyrtwins]

Soundy -

I don't remember if I've mentioned it before, but from what I understand, the ANA will give you tips on how to get your BAHA approved by an insurance company.

If you haven't already contacted them, you might want to.  It's worth a try.

Jan

[Soundy]

I have codes and tips that didn't help with Cigna ...since insurance will change in a couple weeks going to
just stop for now and re-apply under BCBS ... and see what happens ... have til December to get it done
with full coverage ...havea June 17th appointment to go back to the audiologist/surgeon that works 
in conjunction with my surgeon...will go from there

[Soundy]

Still more woes... even though they are no longer calling me pre-existing as far as AN treatment or rather
post surgery treatment they assigned me an additional $1200 in out of pocket calling me a high risk...

they also put my birthday in as 01 (January ) instead of 11( November and somehow my husband is down
as being born in 1988 instead of 1965 which made him just 9 when our oldest daughter was born and 11
when the youngest was born  ...

only found this out when I went to pick up a prescription of hydrocodone and gave them my new card...
after about 15 minutes was told that they were still working on it so me and the girls went and ate lunch ,
got groceries and came back to get the pills ...

was greeted with a manager and a printed page of what they could do to you for prescription drug fraud... had
a what the hell moment... I have been dealing with this store for 20 years... they know me ... and the
medicine was not a new one although one on their list of drugs to watch closely for duplicate orders or
what ever... last bottle filled May 19 and had used 29 from then til July 11... not many considering they call
30 pills a 5 day supply...was going fishing and hiking over weekend and didn't want to risk going into it
with only one pill between me and a headache

They point out problems to me on the BCBS printout and I had to show my drivers license and gave them
husbands old cars with his birth date on it ...was told that it was too late to fix it and I would have to get with
HR person and could come back Monday for the medicine ... I told them just back it out of system as if I had
no insurance and I would pay full price for it ..was told they couldn't do that since it was already in their system...
I asked what would happen someone had something called in and didn't have the money or no longer wanted it ...
lady told me it would be returned to stock and taking of records as a filled prescription... so I say fine , I don't
want it right now take it off... and she tells me I know you will just tell me to fill it after I take it off ... and
said she couldn't do it ... then told me that I didn't want to do it because it would cost me instead of the insurance

I told her I wanted the manager back... I informed him I was getting a headache and
was going to start vomiting all over his waiting area  and really just needed my prescription and to get out
of there ... he took it out of the system and re-ran it as if I had no insurance ...ta-da ... it only took 30 minutes
of my lief to get this done ...and was really in no danger of vomiting but wish I could summoned a just a little


Here is the kicker and what really irks me ... makes me see red...

I had to pay a whopping $5.49 with no insurance ... with CIGNA I used to have to pay $7 and they paid $1.49 ...
on the bag was a copy of the BCBS contracted price and with insurance I would have had to pay $8.50 and
BCBS would have paid $1.50 ... a bit rip off... CVS has contracted with BCBS for the price to be $10 ... but with
no insurance it was less... the woman told me alot of the cheaper drugs were priced like that but I would save
money on anything higher priced... price everything what it costs and a little profit for stores and drug companies
and quit making up a new price for everyone that comes ..they didn't want to back it out and re-run it
becasue they only got the price of the pills... not the jacked up price they get when it goes through insurance

Just one more reason that insurance rates are going up and you get less

well that is my rant for the day... I feel all better yelling it out here ...getting it out of my system
have a good day