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Trigon Blue Cross Blue Shield of Virginia Complaint - fraudulent allowable charge amt on a claim

Review by Anonymous on 2002-04-30
RICHMOND, VIRGINIA -- This company, Trigon Blue Shield is suppose to pay my claim according to the allowable charge determined by Empire Blue Cross Blue Shield of New York since that is where the services for the procedure #62287 was performed on 11-21-00. My doctor provided me with copies of claims and predermination letters on patients insured with Empire Blue Cross Blue Shield and Horizon Blue Cross Blue Shield showing the allowable charge amount to be 7000.00 at the time of my procedure. Trigon
says that Empire says the allowable charge to be 2000.00. All copies of claims on patients that I have From Empire show the allowable charge in the New York area to
be 7000.00. Here we have one of our largest insurance companies practicing dishonest and unethical processing of a claim to avoid the proper payment. I urge all patients submitting claims to Blue Cross Blue Shield
companies to beware because their allowable
charge amounts may not be correct so that they
cheat their paying insured customers and only
pay a small fraction of what they are suppose to be paying.
Comments:1 Replies - Latest reply on 2003-12-17
Posted by Anonymous on 2003-12-17:
It sounds like my complaint is a bit like this one...i call it legalized burglary by blue cross blue shield...
My husband and i always carried this coverage through his company, and although it was expensive, it was one of the best ones around.
Things were fine with it,,,until my husband fell ill and died. This was a result of a car accident we had. He had surgery after it, and never really recuperated. Anyway, what i'm going to tell you might shock you.
He was flown to st josephs here in phoenix, one of the best neurological units in the country, where they did everything they could to save him, but to no avail.
Afterwards there was an ensuing legal case because of the accident. Nothing huge, but would have helped me a lot. Two insurances are involved. The other driver was underinsured and they have settled for a small amount. Banner health, the hospital where he was, submitted a huge bill to my lawyer..something to the tune of 47,000 dollars.
I was shocked, as all the medical bills showed his expenses paid in full after his death. Apparently they say that they have a "contract" with blue cross, where they come to some kind of reduced figure for certain procedures...however.....after a patients death, and if there are any monies received by his estate, they are allowed to come back and bill for the difference of the agreed amount with blue cross, and what they usually charge.
I was floored. My attorney says they can do that. So instead of getting what i thought, i got a very small fraction, after attorneys fees.
The next settlement comes from our own insurance picking up the underinsured on our policy. Again, banner health has stepped and and will claim most of that. the attorney will get way more than i do.
So beware of your medical "hidden contracts" especially between blue cross blue shield and your hospital. Im still very angry over this, because im struggling now, and i was counting on this money to help. Its legalized crime as far as im concerned. Hope this helps someone.......juliek4@cox.net

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