blood administration

[richie rich]

hi guys

it has been awhile since i have been on the site. things are back to normal so i don't have as much time to chit chat.

i do have a question for the board. last july my wife went into the hospital for emergency surgery. she lost a lot of blood and they had to pump her with plasma, platelets and blood. anyway the hospital sent the bill to the insurance company for $50,000 ( retail price) or $26,000 ( real price = pre-negotiated price). one of the charges was for "BLOOD ADMINISTRATION" for $4,500. i wondered what this charge was for but figured that the insurance company would pay it. well guess what. the insurance will not pay for it. "BLOOD AMINISTRATION" is a charge for testing and maintaining the blood that is donated to the hospital. nobody would donate blood if they had to pay so the hospital charges the end-user of the donated blood a fee for the process and testing of the donated blood. Cigna ( which by the way stinks) refuses to pay for it. I think it is a total joke and refuse to pay.

Has anyone had a similiar situtaion like this before?

Thanks,
Richie Rich

 

[hensylee]

Don't know about administration costs, but I would sure challenge it. If you have trouble with your ins co, get in touch with your state insurance commissioner (surely there is one), tell his/her office and they can help you follow through on this.

My sister had an ins co problem and she was going to pay. I would not let her, told her to get a lawyer, but she went to the state ins office and soon she got a letter from the company saying they were paying. You just gotta try something and this is a good place to start. Good luck and God bless

 

[terry40]

Richie rich

Richie rich

There always a way to appeal the insurance decision, I've been doing it for the passed 4 plus months.

Contact your benefits department to ask for help, they can steer you in the right direction, and on the back of the denial statement there should be information on how to appeal, mine was the National alliance of BCBS, (which also stinks)

Keep account of names, and dates of who you spoke to, also copies of any faxes, e-mail and mailings sent.

Maybe the American Red Cross can help out too, since they are the main source of blood collection.

Maybe someone else has had an expierence with administration fees,

Best of luck

Terry40

 

[John Cochran]

During my surgery, which was severely problematic, I believe I received 23 units of blood, plus more in other blood products. I didn't receive any such charge for "blood administration."

From years of experience with our family's medical issues, I know that when there is a major dispute in who pays, and why the insurance company won't pay, etc., that the very best thing to do is get a lawyer to write to both the hospital and the insurance company asking for a full explanation of the services rendered, and why the insurance company won't pay. The implication that litigation may follow is usually sufficient motivation for the parties to get their acts together.

In the mean time, don't pay it.

Best wishes,
--John
P.S. I guess the question I'd have for the hospital is, "Is this a customary and regular charge simply to ensure that the blood products you provide are safe? And if so, why isn't insurance covering it?" The whole thing sounds suspicious to me.

 

[inventory]

Richie-
Everyone is right. The insurance companies are such a pain in the you know what.
I had a major one with mine regarding a pre-existing condition.
Finally I wrote to the State Ins. Commissioner and also went to a lawyer .
Bottom line, after a lot of work on my part and the lawyer doing his thing it was straightened out. It took time, but it was worth it and saved us about $7000 after lawyer.
Don't pay, fight first.
Good luck.
Al

 

[Georgia]

Insurance companies

Insurance companies

I'm an insurance company grunt - NOT medical, thank God; but I write property & casualty contracts. I also deal with insurance departments on a regular basis.

A couple of suggestions in general:

Everyone should have a copy of his/her contract. In addition to the certificate (that's the Reader's Digest version provided to each insured) you should have a copy of the main contract. Your employer has it and can copy it for you.

Read your contract. I know it's boring and complex - but your financial well-beling might depend on it.

If your contract is written something like: "we pay for reasonable and necessary medical care for yadda yadda yadda . . ." and does not list exactly what they pay for (this is most common contract), then generally, if something isn't excluded, it's covered. If you have a problem and speak with your insurer, and they say it's not covered, make them tell you EXACTLY where it says that in your contract. If the csr you're talking to can't tell you that, ask for the supervisor and repeat your request. They're responsible for explaining the contract - they wrote it, they can get their people to explain it.

As previously stated, follow complaint/appeal procedures to the T. Insurers count on people not doing so and then wiggling out of payment.

Don't hesitate to go to state insurance departments. Also, don't hesitate to write to the president of insurance companies. The compliance people in companies are always on the hot seat. No one wants the insurance department on their case. They make life awful for companies, particularly when market conduct exams come up - and many states base their examinations on complaint ratios.

 

[hensylee]

Georgia - just this one post makes being here one of the worthwhile benefits. Where else can we get info like this. Surely not from an insurance company! Thank you. I am keeping this one - my brother is a Parkinson's patient and Sister and I need to know this. Thanks

 

[richie rich]

i want to thank everyone for their responses.

i have good news. i got a revised insurance statement today in the mail. the insurance company reconsidered the charge and decided to pay it in full so now i don't have to pay for the bogus charge.

thanks

richie rich

 

[richie rich]

georgia

i have a question for you i currently work for the illinois dept. of revenue and cigna just denied a test that my wife's surgeon wanted to perform. she has a small liason in her brain ( it is either a tumor or dead blodd vessels which were damaged IF she had a mini stroke. the test her surgeon recommended is called a Spectroscopy. it tests the chemical composition of the area that they are looking at. as of today it is not approved for use by the FDA for brain tumors. it is approved for other medical conditions but not this one. i was told that it will be approved one day but not until all of the clinical test are completed. it does work for brain tumors. anyway to make a long story short......
if it is not FDA approved to I still have a chance to get the insurance to cover it or will it be a long uphill battle.

thanks,
rich

 

[Georgia]

Cigna: boo hiss

Cigna: boo hiss

Rich: This is tough - my guess is that it's clearly in your contract that they won't pay for unapproved procedures - irrespective of the fact that it's approved for other stuff. Further, CIGNA's a bear to get around. They fight for every dime.

However, I truly believe in going to the Insurance Dept. Follow the appeal procedures, and at the same time call the IL DOI. Illinois is NOT a consumer-friendly state for insurance (could that have something to do with State Farm, Allstate, and Nationwide being domiciled here??? Oh, those premium taxes . . .); but because of the companies that are influential here, it's more consumer-supportive vis a vis medical insurance. And there's movement afoot in the legislature to require coverage for those participating in studies. So - I'd certainly be aggressive here. You have absolutely nothing to lose, unless not doing this procedure means something else will be required.

Hope this helps; unfortunately, this particular condition is one of the most difficult because the contracts are usually so explicit on this subject.

By they way - congratulations on getting the whatever fee paid. Isn't it just a miracle? My guess is that someone figured out that such stuff couldn't be excluded in Illinois (and regardless of where the procedure was carried out, the laws of IL apply because the contract is written here).

Good luck.