Thread: Blue Cross decling charges - scam

We all know how much health insurance is right? We pay through our noses to pay the premiums. Will I'm a small business owner so I pay a higher premium (not a lot of employees).

My daughter went in for her physical (she is 14) and she had the new shot for cervical cancer (immunization).

Guess what? My insurance company - Blue Cross - declined the charge. I have to pay $170 out of pocket for this and it's a series of 3 shots. So $170 each time.

What a scam!

Wow, that pretty much sucks! Did you find out why they declined the claim? Is that the somewhat new shot for cancer? I bet it’s because it is still considered experimental. Why? I don’t know seeing that it has been out for years now.

First off you need to call the doctors office and speak to the billing department. Ask them for the reason it was declined. They would have to know. Also did you get a Statement of benefits from Blue Cross yet? If you did, the reason for denial would be there too.

After you find out why the claim was declined, you will want to call the insurance agency. You could of course ask the doctors office to rebill it out to the insurance company. They could have coded it improperly and that could be why it’s declined too. You never know, a rebill might just get the insurance company to pay the charges. The doctor’s office could even change the code if it’s a “experimental” issue to something other than that and see if the claim goes through. I don’t know if they will do that but it is certainly worth a shot.

Call the insurance agency and see what the problem is and what you can do to get the claim to go through. You are super correct, we all pay way too much for our premiums so things should not be denied. I can’t imagine why they are denying an immunization anyway! Perhaps it’s something that was missed by the doctor or perhaps the billing department double billed for it by mistake. You will find all this out by calling them. You can get the phone number from the back of your insurance card. Be nice and they might be more helpful!

What are you going to do if they continue to decline it and it’s the immunization? It is a series of 3 shots you said. I would check with the doctors office to see if with each shot there is a charge or if it’s just all up-front cost (Charged full price for the whole immunization and nothing with the other 2 shots).

Either way, I would fight the claim (denial) you don’t want to be stuck paying this out of pocket and you also don’t want to be stuck paying two more $170 charges! Good luck and I hope you are able to straighten this mess out!

Unfortunately, most people have no idea what their insurance will actually cover. I found out the hard way that my insurance company did not cover birth control in any way so I had to pay $90 every 3 months to go in and get my birth control. You need to read your coverage manual if you still have it just to make sure the Immunization is something that should be covered by your policy.

A lot of people go in blindly thinking they have insurance so they are covered, but the truth of the matter is even if they have something done that should be covered, their insurance company can deny the claim. They figure most people will just go along with the denial and they will not have to pay out on it. It really sucks but insurance companies have been allowed to run roughshod over their customers for decades-denying claims, cutting people off, charging outrageous premiums. I do not see this changing in the near future so the only thing you can do is keep fighting to get them to cover the immunization.

I also encourage writing letters about these types of things to your state and federal Congressman. They have the power to hold these companies accountable and make changes to the laws to make insurance companies do what they are supposed to.