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Blue Cross Insurance Leaves Patient with the Bill

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Torrance, CAEve H. thought she had covered all her bases when she signed up for Blue Cross insurance.

Although she had occasional minor pain for which she took Glucosamine, she made sure Blue Cross was aware of her situation to avoid any trouble from the insurance company.

After she was approved for Wellpoint Blue Cross insurance, Eve decided to see an orthopedic surgeon for her pain. The surgeon diagnosed Eve with bursitis. Bursitis is normally a minor problem, but can be symptomatic of a larger problem such as torn tendons. Eve asked her doctor if she should have an MRI. "He saw no problem with that at all," she says. "He had to write a prescription for it, which he did."

Eve decided to phone a few medical centers to find the best price for an MRI. "I was on something called a 40 plan, meaning there was no deductible, but I had to pay a certain amount of the bill and Blue Cross would pay the rest. I wanted to find the lowest price." Eve found the lowest price at a diagnostic imaging center. She phoned her doctor to let him know right away. "He called the next day to say that Blue Cross had certified the MRI, but I would have to go to Torrance Memorial Hospital to have it done."

Eve's MRI was done in February, 2006. She says she was apprehensive when she got to Torrance Memorial. "It was fancy, like a hotel. Everything looked expensive." But, because Blue Cross insurance said she had to have the MRI at Torrance Memorial, Eve went ahead with the procedure.

A few months later, Eve received a letter from Blue Cross insurance stating that they were investigating her claim for the MRI. Blue Cross said that because it involved pre-existing pain, they would not cover their portion of the cost. Eve then spoke with someone at Torrance Memorial who assured her that it was normal for Blue Cross to investigate claims and Eve should not worry about it.

A month later, Eve received word that the bill for her MRI, $3,000, had been sent to collections by the hospital because it had not been paid. Blue Cross was still claiming that the MRI involved pre-existing pain that they did not know about and therefore they would not pay for it. "Blue Cross certified the MRI. They made me go to Torrance Memorial when I had another place in mind. If I had gone to the imaging center, my portion of the bill would have been around $600," Eve says. "I was under the impression that Blue Cross would pay for the MRI. What is the point of having health insurance when they do something like this?"

Eve is dealing with her insurance agent to see if there is any way they can get Blue Cross to pay. "Blue Cross should let people know up front what they will pay for. They certified the MRI. Otherwise, I would have gone somewhere else for the procedure."

In the meantime, her bill is still in collections. "What enrages me about this is that they have more than enough money to pay for this procedure. They have plenty of healthy people they don't have to pay out for. Insurance companies make a lot of money off this. It seems like a waste."


Wellpoint Blue Cross Insurance Resources

If you or a loved one has had your insurance policy cancelled by Blue Cross and Wellpoint Inc., please file a [BlueCross Wellpoint Insurance] claim which will be reviewed by a lawyer at no cost.


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