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Insurance Carrier: Blue Cross Blue Shield Of Il
State: Illinois

Consumer Complaint:

Mom has ovarian cancer. She is struggling to function on a day-to-day basis going through treatment and working. Mom has to work because she is single and has no other income or benefits to depend on at this point. In '07 Mom had out-patient radiation treatments. I believe in March or April of '08 Mom was notified by hospital that ins co was denying the treatment totaling $26k. Mom called insurance co and hospital over and over to get this resolved but can't get a straight answer as to what the issue is (at one point ins co said it was coding, another time it was pre-cert). Mom also talked to the radiologist's office because they got paid in full but billers couldn't help or understand what the problem was. In less than 45 days, Mom was put into collections and today was told collections put judgment against her pay. We just received papers from insurance co a week ago asking doc to fill them out again!! Collections just contacted her last week too! No one can seem to help or give us straight answer! We NEED help!!!


Insurance Expert Answer:

I feel for you both. This requires a polite letter to the CEO of Blue Cross of Illinois - get his or her name from their website -- requesting compassionate relief and explaining to that person what you told me and asking that they straighten things out.

The hospital expects to be paid -- it does not care from whom. The rate it would charge Blue Cross is a fraction of the rate it would charge you. The collections people don't care. They are paid on the basis of how much they collect. While they can intimidate and harass you, they cannot collect anything or garnish her pay until they sue and get a court judgment, and if your mother is sued, she HAS to defend or bring in Blue Cross as a "3rd party defendant."

Even if there is a judgment, the amount they can garnish is limited, and bankruptcy may be a possibility. If you can get a lawyer to write a letter to the collection company -- perhaps your mother has a prepaid legal plan -- that would end the problem of collection.