Blue Cross Blue Shield Calls Miscarriage "Elective Abortion," Denies Claim


After going without any healthcare coverage for 3 years, (husband’s employer didn’t not offer it and husband and child have preexisting conditions that make self paid insurance imposable to afford) was ecstatic to find out my husband’s new employer did offer insurance! Even though it is at a very high premium and a $2000 deductible, it’s better than nothing, right? At least that’s what I thought, till I tried to use Blue Cross Blue Shield of Kansas City…

Picture: The Blue Cross Blue Shield of Kansas City management team.

I set my daughter up a doctor’s appointment for a well needed check up, and in just one weeks time was sent a statement for BCBS that they don’t cover any of procedures that was done that day! NOT ONE!? So of course I called BCBS and they were very apologetic about this “mistake” and would fix it, it will take about 10 days. A week later I receive a bill from the hospital claiming that BCBS had denied all charges. I called the hospital and told them that BCBS opened a case about this, I kid you not, the billing clerk started laughing, and stated, “Good luck with that!” She went on to say that most of their patients have problems with BCBS paying up. I call BCBS and ask them about the open case on the claim. I was told by Jerri, that someone had just closed the case. She had no idea why they closed it, but was informed that she was “on top of it” and would take care of it, which was Aug, 16, 2007, but was also informed that it can take up to 3 weeks now to fix the problem. Jerri also had a bit of an attitude, which was totally uncalled for and unprofessional.

Now, on Aug, 29 2007 my husband and I suffered a devastating miscarriage. Being near midnight we went to the ER. The hospital was very compassionate about our loss and was able to get us in quickly and expedited our treatment. The following day I called BCBS and informed them that we had made a visit to the ER, and was told it wasn’t necessary to call them just for ER visits, but only when we are admitted. Believing that BCBS would never make the mistakes at they did the previous and only time we have used our insurance I thought everything would go smoothly. Boy was I wrong!

On, Sep, 21 2007 I received a statement for BCBS that they were denying all of the claim. I called them and asked why they were denying the entire claim, and was told by Jane, “We do not cover ELECTIVE abortions. If you chose to terminate your pregnancy for non-health threatening reasons, BCBS will not cover it.” WTF!!!??? I asked her, “Are you saying that my records state that I had an ELECTIVE abortion, in an ER at 12 o’clock in the morning?” It was then, I think it clicked in Jane’s mind what she was dealing with and told me how sorry she was. I lost my cool and even started crying. I had a miscarriage not an abortion, and being treated in such a condescending way by BCBS really ticked me off. Thinking what an incredibly huge screw up, BCBS will be right on it trying to fix this, well you would be wrong. I was told to call the hospital and have them fax over my records stating I didn’t have an elective abortion. Who the heck can get an elective abortion in a busy ER at 12am, anyway?

Mind you we have had Blue Cross and Blue Shield of Kansas City for less than three months, they have denied every claim we have submitted to them. EVERYONE! Even though all claims are clearly covered under our policy, is this the going to be the norm dealing with BCBS? Any help would be very much appreciated!

-Tonya Gullino

That is a horrible, horrible story, Tonya. We are sorry for your loss. The only thing we can figure is that you need to escalate your issue past the grunts and on to someone with a portion of a brain and a silver of a heart left. We can offer several classic Consumerist tactics to achieve that effect…

UPDATE: Tonya writes in the comments:

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