Thursday, July 18, 2013

Blue Shield takes one for the team

The phone rang, and it was not one of those robocalls pretending not to be a telemarketer. It was a real human being from Blue Shield.

In a nutshell, their bad. I can have the MRI.

A longer version:
After the appeal to the state Board of Managed Health Care, an independent radiologist actually looked at the medical records. The evidence of conservative therapy that Blue Shield outright refused to look at. He finds the MRI to be medically necessary. Yeah, this is good news!

If your insurance company ever denies care or coverage here is what I've learned:

  • The appeals process is a sham. Insurance companies never overturn their own decisions.
  • They are allowed to ignore evidence when denying claims.
  • The letters you'll receive will make erroneous claims based on incomplete data. This is known as "an opinion".
  • They have medical professionals on staff to write these "opinions". In my case it was a Registered Nurse Practitioner claiming no MRI was needed.
  • You have to appeal to the state to get results. The other steps are just a means to an end (and a waste of your time).

Mirror neurons, anyone?

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