Pls Advise...Blue Cross strikes again.

[tazdell]

Hi,

I just had a double lumbar fusion on Sept. 29. Blue Cross approved the surgery ahead of time and were generous enough to pre-aprove 2 days in the hospital, surgery day being one of them. Since we all know it is a minimum of 3 days my doctor said it is just a technicality and the office would re-submit why I need to stay longer and it would get covered.

I recieved a letter today from Blue Cross saying 3 days of my hospital stay were denied. My blood pressure was 84/50 for 3 days. Everytime I stood up my ears would ring and eyes go black. The hospital would not let me go in that condition. As soon as my pressure came back up I was walking and was discharged within a couple of hours. I left as soon as I could. I stayed 4 days after the surgery day.

Can anyone advise me on this. Can Blue Cross really do this? Thanks for any input. My doctors office will not answer me until Tuesday of course and I am stressing over a rather large bill that was unexpected. After all....I did the fusion because BLUE CROSS suggested it in their denial letter for ADR. Go figure....Crooks!

Thanks in advance,
tazdell

[Terry]

If the hospital is a Blue Cross Provider meaning, they are part of your network, the hospital cannot balance bill you for the difference. It works this way in Michigan. The hospitals take what Blue Cross pays. The only thing we are responsible for is our co-pays, if there are any in the plan, and, our deductibles, if there are any in the plan.

Don't stress out on this until the lawyers are on your doorstep. Sometimes all these things require is a phone call.

I had an incident with a kidney stone last year where I ended up in the emergency room. They told me if I had continued issues to come back. I had another attack at 3:00 AM and went back to the emergency room. Blue Cross denied this and the hospital sent me a bill for $500.00. I called Blue Cross and they said it was a duplication bill. I told them that it was two separate visits in the same night and they paid it.

Hang in there. It ain't over till the fat lady sings. :D

Terry Newton