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Blue Cross Once Again Denies Patient Coverage

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Rancho Santa Margarita, CABill Stecker thought he was doing the right thing by purchasing Wellpoint health insurance coverage for his three sons.

All three had fallen off his work health insurance coverage because they were too old, so Bill decided to find different insurance for them.

A search on the internet led Bill to Tonik health insurance (provided by Blue Cross). It seemed perfect for his sons. The website says "3 simple health care plans, 1 just your flavor. Apply online, that's it. No catches, no commitments, no wasted time." According to the Blue Cross website, Tonik is a plan for 20-somethings, exactly the age range of Bill's sons.

So he signed them up for the insurance.

Ten days later, one of his sons was having severe pain. He went to the hospital and required three surgeries to fix his problem. Bill was naturally relieved that he had signed his son up for Tonik insurance. Four months later, in October, Bill received word from Blue Cross that, because his son had lied on the Tonik application, they were refusing to cover him.

The "lie" Blue Cross is referring to, was the answer to question 14. The question asks "In the last six months have you had any severe or persistent pain?" Bill says "My son hadn't had any pain at that point, so I answered 'no'. It wasn't until after I signed him up that he had any pain, and at first it wasn't severe. I had no reason to answer 'yes'. The pain came up after the application was filled out and he was approved. There was no lie."

The hospital bills and doctor's fees wound up being around $36,000. Bill says that collection agencies have begun hounding his son for the money. Bill and his son have now hired a lawyer to fight back against Blue Cross for denying coverage. "It blows my mind," says Bill. "I've heard that they've been doing this a lot, denying coverage. I guess they get away with it because people don't want to fight. Well, I'm not afraid of fighting them."

Unfortunately, the hospital bills are in Bill's son's name. "I don't think this is having a good effect on his credit rating," Bill says of his son. "We've paid a small amount of the bills, but now the case is in litigation, so I'm not paying any more."

Blue Cross is a subsidiary of WellPoint. The company is facing a number of lawsuits claiming that Blue Cross is illegally denying coverage for patients who have their insurance.


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