Thursday, July 24, 2014

Houston We Have a Problem

This is perhaps the most collosal #epicfail story involving an insurance company. Since my bike accident on Saturday (sustaining four broken ribs and a collapsed lung,) all pain management methods have failed. Sunday night was a near-death narcotics overdose. My Dr. Recommended plate surgery for 3 of my 4 broken ribs. We started the insurance process with Blue Shield of California. My wife made the first calls. "Can we talk to your husband?" "He's in ICU" she replied in a confused and "are you kidding me" tone. After hopes of surgery yesterday and again today, they denied coverage, but I could do it via outpatient. You realize how ridiculous that sounds--90% of the recommended procedure was to manage the pain. On drugs from my hospital bed, I call from ICU and they tell me I will hear back in 24-48 hours on my latest inquiry. I escalate. I get the same answers, and end the phone call with entering an appeals process which takes 72 hours..business hours that is so I'd hear something by Tuesday. Five days from now and ten days from the accident. Surgery is not happening and the likelihood of all four ribs fusing back together are as likely as George Clooney entering back into Sandra Bullocks Russian space capsule in "Gravity." (excuse the punctiation errors..I'm on like15 kinds of drugs.)

3 comments:

  1. Hello - We certainly are sympathetic to your situation however the ID card number you provided us is not a Blue Shield of California ID. I replied to you via Twitter and encourage you to double check that in fact it might be Blue Cross that you are dealing with. If there is anything more we can do to assist, we will try. - jt

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  2. Sounds similar to our experience with Kaiser-Permanente when our first son was born. Praying for you that they will wake up quickly and approve.

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  3. While my insurance card reads Blue Cross Blue Shield. I am actually Anthem CA. I submitted an urgent appeal which I was supposed to hear back on last Tuesday 7/29. I never heard back. I called on 8/4 and they said it was denied.

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Average guy w/ an above average appetite for marathon racing and triathlons. Ran my 5th Boston in '15. 3:21, 1:29, 19:21 PR;full/half/5K Opinions & wit are mine