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If I get hit by a bus, will Blue Shield pay my medical bills? — Scripting Happiness

If I get hit by a bus, will Blue Shield pay or am I SOL?

Here’s my story about fighting Blue Shield and catching my doctor in a practice commonly known as Balance Billing. I didn’t even know there was a term for this practice until finding stories on Bloomberg Businessweek and Wall Street Journal. It’s appalling to me that medical professionals, who we trust with our lives would engage in this practice. The lesson I learned: 1) ALWAYS read your insurance policy to understand what services are covered, 2) ALWAYS read your bills very carefully as well as the explanation of reimbursement from your insurance company and 3) document & dispute.

Here’s my story (okay, so it’s a bit of a rant too) about my battle with Blue Shield over $144.71 and how I won. It’s not exactly what I’d consider a victory so read on.

How it started…

In 2010, I paid $2,274 in premiums and used it exactly once for my annual OB-GYN appointment, which is one of the few times I get to use my insurance without having to meet the very high annual deductible. In another words, the only time Blue Shield will have to shell out even a single dime is if I get hit by a bus and survive.

According to my policy which I read cover to cover because well, I’m a lawyer and because I do that kind of thing – annual gynecological exams are covered at $30 copayment. This language could not be more clear.

I go to my appointment and faithfully pay my copayment for $30. Couple of months later, I get a bill for $144.71 for? You guessed it. My annual gynecological exam.

I call Palo Alto Pathology Inc, which was about as helpful as throwing both ends of a rope to a drowning man. I call Blue Shield, again completely useless exercise. By this point, I’ve already lost 0.5 hours (that’s 30 minutes in non lawyer speak).

At this point, I’m considering paying the stupid bill and cutting my losses, but the lawyer in me is reeling at the injustice. Besides, it’s the principle of the thing. So, I write a letter. Another 0.3 hours (18 minutes) lost + printing and postage $1.00.

A month later, I get two pages of mumbo jumbo from Blue Shield which in gist says I still owe $144.71. It goes onto say:

“While we acknowledge your feelings, the claim processed correctly according to the services billed…”

MY FEELINGS? Yes, let’s rub some additional salt on the wound and stomp on it too. Do they send this bull s*** form letter to someone who is being denied treatment for cancer or heart surgery?

My story ends with filing a dispute with Department of Insurance, having another two rounds with Blue Shield and Palo Alto Pathology Inc  who insisted on continuing to bill me despite a ruling in my favor, but at the end, I wasn’t scammed out of $144.71. It makes me wonder though, how many others are being scammed in a similar manner and how many of them are fighting it?

It concerns me that someone who is ill may not be in the position to review all the bills with the fine tooth comb necessary to catch these over billing practices. All told, there was over 100 pages of documents I reviewed in my battle over stupid $144.71.

There is something fundamentally broken about our healthcare system. This entire dispute should’ve been resolved with a call and Blue Shield would have just done the right thing – which is to pay the stupid bill and honor its agreement. Instead, I had to get in the mud and fight with a pig.

I’m left with a sense of distrust of Blue Shield, my providers, and hope I never get hit by a bus.


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