• Blue Choice Insurance in Maryland makes no sense at all!!!

    Asked by BeckyTice on Friday, May 17, 2013

    Blue Choice Insurance in Maryland makes no sense at all!!!

    OK... here's what happened. I had a right hemi-colotomy April 8th. I was doing ok but the incision site kept leaking. Then I developed an infection from 2 seroma. My daughter is a GNA so she's been changing the dressing and repacking the seroma twice a day since I got home from the hospital. Now she could use a break. The insurance company has covered and emergency room admit, ambulance to GWU from Calvert County, 3 days in the hospital on antibiotics.....

    I called the insurance company today.... I can't get a home health nurse to come in just to change the packing unless I'm homebound. I can't pay for the insurance if I'm home bound. All I'm asking for is a back up plan.... my daughter is going back to work... at a nursing home where a lot of people need her help.

    I cannot believe that I have to deal with this while I've got two holes in my belly and a pending HNPCC results hanging over my head.

    I almost cried on the phone. I did cry yesterday almost all day long..

    8 Answers from the Community

    8 answers
    • CrazyHarry's Avatar

      If you lived near me, I would come over and help.

      Do you have any real good friends that could help? I've packed my fair share of wounds and have survived.

      One other thing that may help is to get your surgeon to write an Rx for home care.

      Good luck on your healing journey. Sending the best your way.

      over 7 years ago
    • BeckyTice's Avatar

      My surgeon is more than happy to write an Rx but my insurance company will not cover it if I continue to work. If I don't work I can't afford the insurance. It's a catch 22.

      over 7 years ago
    • SueRae1's Avatar

      Hugs. Don't get me started on insurance companies - they drive me totally insane, and what they do and don't cover makes no sense, and they think they know what's best, not your medical/oncology team...end of rant. Here's a link to a website that provides information on organization that provide aid to people who have cancer - maybe one of them can give you a grant to help pay for this cost or provide you with the name of a place that will come in for free - best of luck.


      over 7 years ago
    • BuckeyeShelby's Avatar

      Timing-wise, this probably won't help, since you are on such a tight schedule, but keep in mind that every insurance company has to have an appeals process -- problem is, that usually takes 30 days. I work in the health insurance field. One thing to keep in mind -- it's not just the insurance company; your employer has to ok the plan.

      Are you at all mobile? Can you drive? If so, if the insurance is denying home health, you may be able to have the nurse in your dr's office do it. If you can get there. Lots of ifs. I'm sorry for these circumstances and hope you can find a way through them.

      over 7 years ago
    • abrub's Avatar

      Ask if the insurance company will pay cab fare for you to get to the dr's office for care?

      Remind them that if you don't have appropriate care, the insurance company will have higher expenses, dealing with more ER and ambulance calls and visits.

      You may want to contact Laurie Todd, the Insurance warrior (whom I know - this isn't "advertising") She knows how to get things to happen really quickly. I'll send her a note so that she can see this. http://www.theinsurancewarrior.com/

      over 7 years ago
    • abrub's Avatar

      From my expert:

      "She just needs to see the guideline that the decision is based on -- and document the irrational position of the insurance company in the appeal."

      I'm recommending you fax them an appeal request and call - push them. Laurie's long answer:

      "My thoughts are that she needs to appeal it -- in writing. Since an appeal is a direct response to the stated reason for denial ... she first needs to know what the insurer is basing the denial on. Is it their own medical policy statement, guidelines, or what?

      Once she finds out what the denial is based on ... she then needs to get a copy of the medical policy statement or guideline, and study it closely. With all of these guidelines and med policies ... it is always possible to prove either that you fit within the insurer's own guidelines, and they have to pay for it for that reason ... or their guideline has no validity and no basis in fact, and they have to pay for it for that reason.

      Tell the Bad Medical Story and the Bad Runaround Story in the appeal, quote the guidline or med policy in the appeal and prove your points about it. Then, most important is to leap over the appeals department and fax/email it to the top-level decision-makers at the insurer (and employer, if self-funded)."

      over 7 years ago
    • BeckyTice's Avatar

      I think I'm going to war with the insurance company. I line the warrior's ideas. I have two more red spots showing up now.... maybe a couple more seromas getting ready to cause an issue?

      I called the primary care doctor's office to get some input. They're on vacation...lol!

      over 7 years ago
    • abrub's Avatar

      More from Laurie:

      "Tell the story in your appeal -- without emotion, and with facts (names and dates). Fax it to the top executives, and you will win your appeal."

      Show the insurance company you can fight like a girl!

      over 7 years ago

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