I knew this would proably would happen, but just was not prepared for it!!!!!!
I called the Medical Director at BCBS, he stated he was looking out for our safety due to the outcome of the charges made against Dr. J, HOGWASH. I have a call into this guy's boss I'm sure he won't call back though.
Also I've made a complaint with the NC Insurance Commisioners Office, I just stated I feel I am being denied treatment due to my codition Borrelia burgdorferi.
I just do not know what were going to do!
Jo
Posted by ConnieMc (Member # 191) on :
Hogwash ... you have that right!
It is all about $$$.
Just wanted to clarify ... he is no longer in their network, but isnt he now considered out of network, meaning they still have to pay a percentage of the charges after the deductible is met?
I am also under BCBS and they havent paid my Mar or June visits. Seems they are making this retroactive, which seems downright illegal to me. They have been holding all bills for months and not paying anything. They were intentionally waiting for the hearing to come and go so they could then "protect us" from this doc.
I feel discriminated against because I have a disease that is so politically incorrect. There is nowhere else to go for treatment, and they know it.
I hear from a good source that the NC Dept of Insurance has not even responded to numerous complaints about BCBS. Seems they are in bed with one another. Wouldnt be at all surprised if we didnt eventually find out that they were behind the scenes aggressively lobbying for Dr. J to go down.
This isnt over yet. If we pool resources and file a class action lawsuit claiming breech of contract, then we may be able to overturn this. Strength in numbers.
Posted by stella marie (Member # 7216) on :
Yes he is considered out of network. For me that means a $2,500 deductible then BC/BS picks up 60% of bill.
Funny thing... I just spoke w/ ins.co and they are telling me that he is in network, he is still on their website as in network, go figure.
Then I spoke w/ the Clinic and was told as of June BC/BS dropped then as in network. This was stated before on this board by a few others.
I also have non payment from BC/BS as of Jan., March, and June appts.
I guess when one of 'their' loved ones gets sick and needs the doc's expertise, maybe things will slowly change.
Stella Marie
Posted by lou (Member # 81) on :
When the friends and relatives of these people need treatment, they get it. And keep quiet about it. Do you need any more evidence of dishonesty?
Posted by stella marie (Member # 7216) on :
I'd like to hear more about that Lou......by the way how you doing these days, same?
I was thinking about you the other day.
Posted by 5dana8 (Member # 7935) on :
Jooooo2
I don't know if this would apply to you but mimi went threw this recently. You may want to back paddle threw a few days ago. There was alot of helpful suggestions provided.
P.S. Also might want to look threw char's and ConnieMcs recent posts too.
I know- this really Posted by Lymetoo (Member # 743) on :
I hope you can get some help. This would send me through the roof too in more ways than one!
Posted by stella marie (Member # 7216) on :
The clinic stated BC/BS have a separate legal/medical dept. devoted to Dr. J's claims.
Posted by Jooooo2 (Member # 1621) on :
I went out to water my gardens (desert) & sweat off some steam, it is so hot & dry here!!
Thanks, for clarifying Connie your exactly right But who can afford to go that route I've been seeing Dr. J every six weeks.
I checked their site and they have paid all my claims through 6/27/06. But they can still take it back track, I know.
When I spoke with the rep at the ins. commisioners office of NC he stated they had gotten a lot of calls in May & June about Lyme treatment & BCBS's non-payment.
He thought the problem must have been resolved because the calls have stopped. I assure if I have to go to Raleigh & speak with Jim Long directly I will!
Govenor Easley is another one to contact he appoints the folks Medical Board.
While I was out Steaming, the guy's boss called back, he is the Excutive Medical Director - Robert (Bob) Harris @ BCBS.
So nice of him, he left me a ladies name and number that I should call that could help me find another Doctor.
Funny thing is I did not tell the secretary why I was calling, just left my name & number.
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