Appealing

I’ve documented MLB’s recent frightening, successful surgery. The recap can mostly be found in this tbbs archive link. MLB and I aren’t ones to either grouse about our ailments, nor to recount the details of our medical history to the world, but it’s mainly all there anyhow.

My employer-provided Blue Cross/Blue Shield has come up shining in terms of coverage; hospital bills¹ have been settled, the miscellaneous charges for pharmacies, specialists, et.al., have all been settled and paid in full. Net cost to us: $0.00.

Until last Thursday. The BCBS settlement for the surgeon arrived, a tad north of $14K. Attached was a check, for around $1500.00, which the surgeon gets. MLB will deliver that check tomorrow. BCBS codes indicated that the charges presented were over their allowed amount for the procedure. Bottom line is, that we are potentially on the hook for around $12K for the surgeon’s services.

MLB called BCBS earlier today, and explained the situation. The BCBS lady was helpful, and explained how we file an appeal on a claim. We’ve drafted the appeal letter, and those papers go out via snail-mail² tomorrow. My employer’s HR was very helpful; I’ve filled them in on the details; to the extent they can, they offered their support in getting this claim paid.

We can pay the $12K or so, if that’s how it sugars off³. I wanted to get this on the record, though. And for the record:

1. Repairing a duodenal rupture is not elective surgery.
2. Under emergency conditions, treatment for the above affliction can not be shopped around.
3. Probably, the treatment for the affliction would not arise in other than an emergency condition.

I’m not railing at my employer, BCBS, Reston Hospital, nor the surgeon. I’m simply documenting. While I’m documenting, I pointed out to MLB that the surgeon’s fees were enough for two funerals.⁴ . I then quickly mentioned that if we wind up owing the $12K, we’ll pay it. And be thankful we can.

I’ll keep y’all posted.

-k-