Blue Cross: Miscarriage = Elective Abortion

kpete

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Tue Sep-25-07 01:37 PM
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Blue Cross: Miscarriage = Elective Abortion

Blue Cross: Miscarriage = Elective Abortion
by eugene
Tue Sep 25, 2007

Just when you though Blue Cross/Blue Shield could not get more thoroughly evil, they go out and prove you wrong. As Markos tries to get those murderers to cover a basic CT scan, a Kansas City woman has a bigger problem: Blue Cross/Blue Shield is refusing to pay for her miscarriage claim, saying that in fact she had an "elective abortion."

eugene's diary :: ::
From Consumerist, which broke the story yesterday, the details of what happened in the woman's own words:
http://consumerist.com/consumer/complaints/blue-cross-blue-shield-calls-miscarriage-elective-abortion-denies-claim-302980.php

On Aug, 29 2007 my husband and I suffered a devastating miscarriage. Being near midnight we went to the ER. The hospital was very compassionate about our loss and was able to get us in quickly and expedited our treatment. The following day I called BCBS and informed them that we had made a visit to the ER, and was told it wasn't necessary to call them just for ER visits, but only when we are admitted. Believing that BCBS would never make the mistakes at they did the previous and only time we have used our insurance I thought everything would go smoothly. Boy was I wrong!

On, Sep, 21 2007 I received a statement for BCBS that they were denying all of the claim. I called them and asked why they were denying the entire claim, and was told by Jane, "We do not cover ELECTIVE abortions. If you chose to terminate your pregnancy for non-health threatening reasons, BCBS will not cover it." WTF!!!??? I asked her, "Are you saying that my records state that I had an ELECTIVE abortion, in an ER at 12 o'clock in the morning?" It was then, I think it clicked in Jane's mind what she was dealing with and told me how sorry she was. I lost my cool and even started crying. I had a miscarriage not an abortion, and being treated in such a condescending way by BCBS really ticked me off. Thinking what an incredibly huge screw up, BCBS will be right on it trying to fix this, well you would be wrong. I was told to call the hospital and have them fax over my records stating I didn't have an elective abortion. Who the heck can get an elective abortion in a busy ER at 12am, anyway?

Mind you we have had Blue Cross and Blue Shield of Kansas City for less than three months, they have denied every claim we have submitted to them. EVERYONE!

Wow.

Just...wow.

She goes on to explain that nothing she did could have possibly been construed as an elective act:

I just got off the phone with the hospital and was told that the claim was not miscoded. The billing clerk told me that the wording clearly stated that I had had a spontaneous miscarriage and not an elective abortion. I was also informed that this is common practice with BCBS of Kansas City to deny miscarriage clams as an "elective abortion."

For those that wondered, I didn't not have a D&C. The miscarriage was complete before I arrived at the ER.

more at:
http://www.dailykos.com/storyonly/2007/9/25/104944/188