UPDATE Uggggggg Insurance Problems AGAIN

**KKCondrey** · 03-31-2005, 05:14 PM

Okey, I am no pro at health insurance coverage but I have a stupid question.....

Do you have to meet the deductible as a whole (our's thru Joes work is $300) meaning mine is meet.....but do we have to meet that for each person that is covered.

When I called and told them I was pregnant they said the baby would be covered from birth......now we are getting all the bills for her (Hospital/Nursery bill, Newborn Check up, and one month check up) and they all say DEPENDENT NOT ELIGIABLE

I'm about to drive to SC and blow up the BCBS building

I've tried calling and keep getting automated stuff and left on hold FOREVER so I finally took the adive of the recording and registered on their website and e-mailed them instead.

Now while I am waiting impatiently for their response, please someone tell me that all we have to do is meet the $300 deductible for her as well.

I really hope that is all it is, if not, I have no idea what we will do

**Daphne** · 03-31-2005, 05:34 PM

It depends on what your coverage is. Sometimes it's $300 deductible per person or a $900 family ded for example. If it is the 900 ded and you had a family of 5 then you would only pay the ded for 3 of the family members per year (calendar or contract). I would say that if you had a family ded of only $300 then in my opinon that is great coverage as far as the ded is concerned. But I would guess that each of you have to pay the $300 deductible. Were you able to find your benefits online - it should break it down for you. I understand your frustration with BCBS but hopefully the website will help you out.

I hope I didn't confuse you more with my explanation.

**PrairieRose** · 03-31-2005, 05:46 PM

We had an insurance once Kat that would not cover the well baby charges. Like if the baby had been ill or had birth defects it would have been covered. It also would not cover well baby check ups. I have an idea. Have Joe talk to someone in charge at work about it. They might be able to contact the insurance company for you

You'll get it sorted out. Sometimes it takes months and months to get hospital bills paid by the insurance. One more thing. If the baby has a deductable ($300) then after the insurance pays all the other bills, call the hospital and ask (if you have the cash or credit card on hand to do this) how much they will discount if you pay the balance in full. Sometimes they'll knock up to 1/2 off. Good luck sweetie, don't sweat it, you'll get her paid for eventually.

**paelthom** · 03-31-2005, 06:15 PM

Hope this gets settled soon Kat. Insurance companies can be hard to understand and hard to get along with. Mine has a $1,000 deductible on me and another $1000 deductible on Ryan.

**mom22grls** · 03-31-2005, 07:06 PM

Did you fill out paperwork for the baby? Let them know the baby's b-day & SS# and all? We had to do that before they'd pay.

Also, we only have $200/year in well baby...including shots...so we had to pay a gob of money that first year out of out pocket.

Our ins is $1000 deductable per person max of 3....so total maximum deductable per year would be $3000.

HTH.

**KKCondrey** · 03-31-2005, 07:33 PM

okey. I registered Joe on the South Carolina BCBS website since thats where ours is out of. I clicked on all my claims and they said APPROVED, I clicked on Paige and they said DENIED (last year when they were waiting to see if I had additional insurance all mine were denied as well).

Anyway, I then clicked the link for DEDUCTIBLE/OUT OF POCKET and on my name it said DED MET $300 on Paige and Joe it said
DED MET $0

Do you think this means that most likely once we get the deductible met for her that it will start kicking in, or have we found what our taxes will be paying for.

**mom22grls** · 03-31-2005, 08:07 PM

do you have the paperwork from BCBS that DH got when you signed up for the policy or when he started that job?

It'll say on that what you're required to pay on the birth and well baby.

And if you need to fill out paperwork on the baby or if you just need to call them & tell them the baby was born.

**mom22grls** · 03-31-2005, 08:12 PM

Also, I see your baby was born in Feb.....it can take MONTHS to get it all done. The hospital will wait for the money. If they're calling for payment arrangements, just tell them you've got to work it out with BCBS. They WILL wait & it won't hurt your credit.

**crdurham** · 03-31-2005, 09:43 PM

I used to work with insurance companies and will be glad to help you any way I can...

When you get your EOB from where they processed your claims, it will tell you why the claims were denied. I had to call and call and call the insurance company when ds was born and they finally got it all paid. Since Paiges name come up, it means that she is covered on the plan. You should also be able to look at the EOBs online if you haven't got one in the mail.

As far as the deductables, most of the time it is per person but sometimes it is per family....your insurance company can tell you for sure....

when you call them, if you hit 0 after the recording comes on, you should be sent to a live person...tell them you are a claim holder and need to talk to someone....they will transfer you...it should help you not have to wait so long...

and call me if you need any help with this....I know my way around insurance problems.....lol

**KKCondrey** · 04-01-2005, 10:01 AM

Okey, I looked thru all the claims listed for her and on the back it first said......"......Benefits begin once you meet the deductible"

Although there was a *01 beside each amount on the break down of her bill and this is what it said in the remarks section:

ACCORDING TO OUR RECORDS, THIS DEPENDENT IS NOT ENROLLED FOR COVERAGE. FOR ASSISTANCE PLEASE CONTACT YOUR EMPLOYER PERSONNEL REPRESENTATIVE.

So I know the hospital did there part by calling and adding her like they said they would when I preregistered before giving birth, so I am guess that they failed to tell us that we needed to contact Joes employer since that is who the policy is thru.

I'll have Joe take the SSC of hers that just came in and the info to order the birth certificate for her to work with him Monday and call the home office and see if they can't get it straight. He is off today or I would have him do it now, but Monday's are fairly slow so he should be able to get away for a few minutes to call them.

**KKCondrey** · 04-01-2005, 02:30 PM

Here is the e-mail we got back from BCBS:

April1,2005
Dear Mr. Condrey:

Thank you for using our Website to ask us a question. You asked why claims on your newborn daughter have not been being paid. We have researched your question and found that your daughter has not been added to your plan. Please contact Ryan's Human Resource Department and ask them to contact our Membership Department to add her. If you have any further questions, please do not reply to this email. To ensure your privacy, submit your inquiries through "My Insurance Manager" at www.SouthCarolinaBlues.com. It has been my pleasure to assist you.

Sincerely,

Web Services
Member Service Representative

Joe's already left a message at the benefits department for them leave him a message at the store this weekend so he will know what info they need from him on Monday.

I really hope that is all it is and things will start getting taken care of. Then again, I first went to the Dr. in June and it was Nov. before my claims were approved and started getting paid.

**paelthom** · 04-01-2005, 02:37 PM

How about an extra hug for having to put up with all this baloney!

**KKCondrey** · 04-01-2005, 02:42 PM

Thanks Pat

if we owe a deductible for her we are going to use part of our Tax refund for that and if not we are going to use half of it on my hospital bill and hers and then start making payments (hopefully by this time next year they will be paid off.) Of course once I start working I will pay more then the minimum payment as well as extra on my car so I can get them paid off quicker.