Ugh. I'd say change your insurer ASAP and not deal with those fools. Say, at the next open-enrollment period.

There is a special circle in hell for insurance companies like this.

Mene, mene, tekel upharsin.

Weird, I've had BCBS of KC for several years and never had a problem. After reading this though, it makes me really glad that I just canceled to join my employer's insurance plan.

Please tell this lady to email Michael Moore at: michael@michaelmoore.com with her story.
Also, tell her to let BCBS know that if her coverage for this incident continues to be denied, that she has notified Michael Moore and will also be seeking coverage from her local media.
I believe this should help move things along in her favor.

Uh Buran, I think the point here is that she doesn't have any other insurance options. Many smaller companies (if they offer insurance at all) offer one carrier only. And as she stated, she's lucky to have that.

I recently signed on with BCBS and even more recently made an ER trip for some stiches for my son. Haven't received a bill yet. After reading this, I really can't wait to see what I'm in for.

I nominate this post for most horrible thing an insurance company has done since Katrina.

Insurance companies are notoriously corrupt and backwards, and will find any reason not to support a claim. I'm very fortunate that my wife works for a great hospital, and she gets almost 100% of her visits covered while I get a very large chunk of mine covered.

The bit about the miscarriage is especially troubling. I have a family member who has had a couple miscarriages and I can tell you it's a horrible thing to go through.

BY WARF0X0R AT 12:52 PM
"I nominate this post for most horrible thing an insurance company has done since Katrina."

I second your nomination!

This is a shocking level of incompetence and insensitivity. The entirely lineup pictured above should be shamed beyond words.

Apparently, it's quite common for an insurer to reject miscarriage claims, because the procedure is often listed as a D&C, which the procedure most often used in a voluntary termination.

My husband always used to have his insurance claims denied. I'm not sure why. My insurance is almost always smooth sailing. I may not be happy with my benefits or their cost, but I've never had a claim denied. I have BCBS-MN, btw.

Love the photo! A somber, all-occasions bouquet of old white guys accented by two meaningfully placed tokens: the black guy off to the side and the old white lady down in front.`

@Buran: Wait a minute. From everything I've read, BCBS is supposed to be the best healthcare option out there but I guess its all relative. This is fucked up. I'd call the local consumer reporter anyway- whether they start to coooperate or not.

A miscarriage is also sometimes referred to as a "spontaneous abortion", which might be another reason a claims adjuster would mistakenly deny the claim. Not to imply that such incompetence is in any way acceptable.

If there was ever a truism to health insurance it would be the part in the movie The Incredibles, with the little prick manager telling the employee (Mr. Incredible) to deny claims because it makes the share holders happy.

Never seen it, go pick it up. Great movie

BCBS has many different regional plans so maybe KS is just horrible. However, BCBS of GA is my favorite insurer of all the ones I've had in the last 8 or 9 years. I've never had a claim or procedure denied and never had a claim problem.

When I was pregnant with my older son I was in the hospital for a week, and I didn't even have a copay. That pregnancy probably cost them over $30k, and I paid $10.

The plan we have now is Humana and I think they're trying to screw us by saying we have a deductible for every claim, however we don't. So we always have to go back and make them reprocess. I did overlook one and ended up paying for something I wasn't supposed to. I think they count on that.

It is also possible that the hospital coded her claim incorrectly, which is how they got an elective abortion denial.

Jesus, Anya, that's an awful story. You'll have to go over the heads of the ground-level customer service people and insist on speaking to a supervisor. If you get no satisfaction from the supervisor (and make sure you get their name and direct phone#), then do like Homerjay said and call your local TV consumer reporter.

Insurance executives will all be giving Hitler pedicures and blowjobs when they die. That is all.

Ugh.

When I was a kid, my folks had BCBS of Massachusetts and as far as I can recall, they were always wonderful.

Sad to see how things change from state to state.

BCBS has fucked so many claims up here in my hometown (in NC) that the hospitals here refuse to accept that insurance. Since the two main hospitals here are both run by the same people, that means you have to go to the next town over if you want your visit covered by your BCBS insurance. Although it sounds like that might not even happen. They suck!

BY ERRATAPAGE AT 01:05 PM wrote:
"Apparently, it's quite common for an insurer to reject miscarriage claims, because the procedure is often listed as a D&C, which the procedure most often used in a voluntary termination."

Insurers will try to interpret many procedures to deny claims. A D&C is preformed as a result of symptoms due to an abnormal pregnancy or threatened miscarriage
(see [www.medem.com]
cfm?article_ID=ZZZ94S7ISWC&sub_cat=2006).

If not attended to by a health care professional, ectopic pregnancies can result in permanent damage to your reproductive organs, intra-abdominal hemorrhage, and in extreme cases the condition can be fatal.
If a doctor made the decision to do a D&C it was most likely a necessary procedure.

pparently, it's quite common for an insurer to reject miscarriage claims, because the procedure is often listed as a D&C, which the procedure most often used in a voluntary termination.

@erratapage: Which means that they probably know that some of them are miscarriages and are using how the procedure is listed as an excuse.

She should tell her husband he should let HR know what kinds of problems they've been having. If this is typical throughout the company then they need to switch providers next year. I'm sure the company isn't paying BCBS to leave their employees out in the cold.

@alice_bunnie:

you can still go back to humana and make them repay it correctly, and then get your money back from the provider of service.

@homerjay: Good point. I agree with this - FILE A COMPLAINT. Please!

From what I've heard, BCBS tends to be expensive. Really expensive. For what I hear people pay, I'd expect better treatment of customers.

Since you have BCBS of Kansas City depending on if you live in Kansas or Missouri you might be able to file a claim with your states insurance commissioner.

The Kansas insurance commissioners site is:

[www.ksinsurance.org] - You can file an online claim on the website

The Missouri insurance commissioners site is at:

[insurance.mo.gov] - You can file an online complaint here as well.

Not sure if it will help but good luck.

One of the major problems with the health care industry is that is not consumer friendly.

On the first point where her claim was denied - had she meet the deductible of $2000? BCBS usually offers a wellness exam for kids - was this coded as such? I am betting that she still needs to meet this out of pocket deductible

As for the miscarriage - she should not have been denied if she has met her deductible - does she know her coverage for ER visits? Some insurance it is $100 AFTER you meet your out of pocket deductible.

If all of her claims have been denied - has she shown that there has been no lapse of coverage? She needs to send information about her last insurance dates to BCBS.

Having a very very close family member who deals with insurance companies and claims on a daily basis - her response is always if you don't like what the adjuster says on the phone - hang up and call a different one.

Until she can sort this out - she will have to pay the medical bills.

As I said - insurance is not consumer friendly.

@samiamiamsam: My mom had to battle BCBS over the spontaneous abortion tag for a miscarriage twelve years ago. I was too young to know how it got resolved - I know that it did - I just remember it being awful.

[www.dmi.columbia.edu]

ICD codes are how healthcare providers and insurers communicate diagnoses for billing purposes. The ICD-9 for Spontaneous Abortion ("miscarriage") is 634 and Elective Abortion is 635.

This could all be due to an extremely unfortunate typo, but even then, BCBS should be falling all over themselves to apologize in this situation. (Unless they are inhuman monsters). And sadly, it seems that if there is anything out of the ordinary, the computer programs at an insurer deny by default.

I seriously doubt that any insurer pays for services billed under 635. I also assume that almost every insurer will pay for appropriate services for 634.

But a bill comes into the BCBS computer with 635 and is automatically denied. And heaven help the victim of a computer fed faulty data. It's now up to the patient to prove that she didn't have an elective abortion.

Please also send a copy of your complaint to your state legislators and state medical association. Not that the government can help at all, but they can't do anything without hard evidence that something is going on, and one more letter can't hurt. The AMA also uses this information to help them pass patient advocacy legislation and every little bit helps. The Blues are notorious for this type of thing.

I used to pay $60/month for $7500/year deductible insurance from BCBS of Oregon. When I broke my leg and needed a titanium rod implanted, the bill w/out insurance would have been about $35k. Insurance reduced it to $23k, and since it qualified as an emergency, I only had to pay $2k. That seems like a pretty good deal.
And as for the original poster, it sounds like the whole "spontaneous abortion" thing. I'm sure it'll work out.

Until two minutes ago I was against a National Health Plan. I just changed my mind.

Call the press... Find every news outlet you can that will pick this us.

I think I know how this happened. Doctors often have to perform a D&C (dilation and curettage) on women who've miscarried. For lack of a prettier phrase, they have to clean out the uterus. This is the same procedure that's done in a "regular" abortion. So looks like BCBS's system is set up to lump all D&C's together (regardless of the circumstance) and try to get away with not covering any of 'em. Go America!

Wow. I know it's BCBS's policy to generally deny every claim right off the bat or "accidentally" close it, but this...this is a whole new low. I hope these assholes burn in hell!

An emergency room will NOT do an elective abortion. Someone at BCBS has rocks in their head.

She should be able to get a copy of the paperwork submitted by the hospital by simply calling or going there in person to the business office. She could easily determine if the proper code was used or not. That should help with getting it fixed. If the hospital did use the right code BCBS will have some explaining to do. If the hospital did screw up they can fix it and resend it.

If BCBS is not playing nice please do contact the insurance board in your state. They can put pressure on a naughty insurance company.

As for the perpetual denial of claims. We ran into this with our employer provided insurance sponsored by one of the local hospitals. They denied every single claim we submitted for six months. If they didn't deny them they would "lose them". I found out from a couple of the local clinics that this was oh too common for this insurance company to just pretend they never got paperwork. So to get around this I had to go get copies from said clinic and hand deliver them AT the insurance company office to an employee from claims processing. I also made them sign the copy I was keeping for proof they got it.
Ironically after that rather uncomfortable exchange our claims are getting processed. It seems they didn't like having insureds showing up, even polite ones.

BCBS owes this woman a huge public apology and she should go to the media with this.

BC/BS is managed state by state, so your quality of service depends on where you are. It's been good to me so far, but I'm in Michigan.

My GP, however, frequently miscodes and then attempts to charge me full price. I'm fairly sure it's them and not my insurance, because there's a consistent pattern of what gets denied, going back to when I had other insurance - not to mention that the four specialists I'm seeing (dentist, etc.) have never given me a full price bill for a covered service. It's possible the hospital miscoded, and it's possible that BC/BS of Kansas stupidly misinterpreted the claim.

If we had single payer health care, we wouldn't have to haggle over the phone with someone on the other end concerned about company profits and quarterly reports. Don't forget to executive carpet bomb your congresspeople too!

Try to find someone sympathetic in your local media (perhaps an investigative reporter) to report on your experience. Explain what you've been through in exactly the same clear way you explained it to The Consumerist. Our local newspaper has done investigative pieces regarding regular people getting screwed by their insurance companies and *surprise!* very often, the companies have followed up by stating that they will be taking care of the mistakes.

Also contact your state insurance commission and file a complaint. The insurance commissions in some states are more on the ball than in others, and I don't know how yours stacks up.

I do wish you well.

I've been with BCBS for about three years now and never had an ounce of problems. That is until last week when I got a "late" bill from my last doctor saying they had denied by doctor's appointment due to lack of insurance. I had this appointment 15 days before I switched from my BCBS insurance to my husband's. So I'm not looking forward to the mess of fighting I'm going to have to do either. That being said, this is inexcusable behavior. I'm very sorry for the miscarriage and the horrible treatment. I couldn't possible hate insurance companies any more than I do right now.

just goes to show what a sad state our medical practices are in one of the most richest country. this story is moving up on digg, hopefully it will get more attention it deserves and she finds resolution (like a different health insurer)

I too have had issues with BCBS. Texas (Fort Worth Area), as opposed to KS. I had an ER visit for what I expected to be an alien in my skull (incredible head pain that I could not function with). The billing folks at the hospital CALLED the lovely BCBS and they gave their approval for me to be admitted, along with approval for several tests. Two months after I was released, I was billed for approximately $14k for that stay in the hospital-and BCBS denied all but approximately $100 of the entire visit ($100 was my ER co-pay mind you). Years later, I will still not pay the bill, the coverage was not over any bounds and it was ALL pre approved.

I give UP!

I am sorry Tonya, for your loss-Godspeed.

I'm the writer of this letter. I just got off the phone with the hospital and was told that the claim was not miscoded. The billing clerk told me that the wording clearly stated that I had had a spontaneous miscarriage and not an elective abortion. I was also informed that this is common practice with BCBS of Kansas City to deny miscarriage clams as an "elective abortion."

For those that wondered, I didn't not have a D&C. The miscarriage was complete before I arrived at the ER.

I have been contacted by the media. I want to thank you Ben and for all the supportive comments, you all have been a Godsend.

Tonya Gullino

I am glad you've been contacted by the media. Your issue will be resolved for sure now.

Sure am glad I live in Canada..

My wife and I have had BCBS of California and had no end of trouble. They would routinely deny claims request more information, then deny again and ask for more information.

We had a kid in July and the last claim wasn't paid until the following June. Obviously, every region has Blue Cross administration of its own, but your story doesn't surprise me at all.

Another case: wisdom teeth procedure. Called insurance and there was exactly one Oral Surgeon that was "in-network" in the whole state (we're in another state, using CA insurance, part of the nightmare). So we drive an hour each way to get the procedure done. That was 8 months ago and they have have yet to pay the claim.

I'm happily in another job with a different insurer now.

Good luck.

Tonya, good luck. I hope local media coverage gets some BCBS action in your favor for a change. I trust Consumerist will follow up on your story here, too. Having a miscarriage is bad enough (BTDT) without this additional horror.

I work in a medical clinic and I deal with the terrible administrative on goings at insurance companies. I would HIGHLY suggest that anyone having a problem with their insurance, doument all exchanges with them and then right your state insurance commisioner and your state representitives. They need to be aware of these problems! Make sure you send the same letter to your insurance company!

I have insurance through BCBS TN with a maternity rider and it states that the "Maternity rider must be in place for 10 months before benefits are provided." (For the two months it took them to approve my application, I prayed extra-hard that I wouldn't accidentally get pregnant.) Since she's only had the insurance for 3 months, could they be trying to deny the insurance because those 10 months had not elapsed? I thought we would be covered if conception occurred after I was approved for the policy, but now I'm wondering if they will cover anything related to pregnancy until that 10 month mark. Tonya, I am so, so sorry that BCBS is putting you through this.

I would consider suing the hell out of them. "Bad Faith Insurance" doesn't adequately describe the horror of the situation, but it is a valid legal claim, and may apply in this situation.

@alice_bunnie: BCBS of Kansas City is rather Missouri and Johnson/Wyandotte counties in Kansas. The rest of Kansas is a different BCBS.

And yeah, they have a reputation for pretty much denying everything.