I've been trying to get Blue Cross Blue Shield to pay for portion of my surgery bill from one year ago. We've had to pay the surgeon for this portion out of our pocket to keep it from going to collections. The deal is, I elected to have my ovaries taken out at the same time as my mastectomies because I'm BRCA2 positive with BRCA2 comes a high risk of ovarian cancer.
Got the verdict from BCBS yesterday and its a big fat no. The oophorectomy was elective. I really don't think it was elective. I bet 100% of oncologists would recommend it for a BRCA patient. You'd think BCBS would be interested in paying for preventative procedures that hopefully avoid further cost to them, in the form of astronomically expensive chemo treatments.
I'm not ready to give up yet however. There is a website called FORCE that deals specifically with BRCA gene mutation issues. Maybe someone there has tried to influence an insurance company to pay for a claim they initally deny.
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Laurie - You just have to keep up the fight. I work in the insurance industry. Talk with the adjuster and explain the situation. Insurance claims are not black and white. You just have to make your case. My boss had to get in the face of BCBC to make them pay for a surgery for her son. She had to put a lot of time into it, but got it done. Be persistant. Don't quit.
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