blue cross blue shield insurance.

[grenada]

hi guys,

this is the first time i have had insurance in my life. I finally got it. But i had a few questions. Lets say something happens within the next month and i have to go to the ER department and the bill racks up to 10 K . Will the insurance try their best to not pay it and come up with every excuse they can??

2.) If i go to a doctors office for lets say heart burn, and I am discovered with peptic ulcer, will i be told before every procedure is performed about what will be covered and what will not be covered?? Lets say upon examining my GERD i am discovered with peptic ulcer will the insurance backaway from paying since an ulcer typically takes a month to develop and its a pre existing condition??

[Nikopapp]

I have had Blue Cross/shield for 4 years now, and I have had a few problems here and there.
If you go to the ER and have something wrong, they will cover it.
But, if there is something that could be construed as pre-existing, they will do their best not to cover anything on that.

[GoneForever]

Luckly im on the blue sheild/blue cross Excellus plan which is what most of the corperates are on and few dr's can get on this plan as well. Luckly I had a good connect, but even on this plan, even though pretty much everything is covered, you still always have to ask. First off people think insurance companies are more powerful that they are. You just have to know what to say and what not to say. If you went in now and racked up 10k in bills they have to pay they're % even if its the first day. But they will try everything they can to burn you b/c they are all scum so just make sure to never say anything is pre existing. If you go in for heartburn, just say you started getting it the first day you were insured b/c there's a chance they could say "well you never put you had heartburn down when you first signed up so its pre existing" Now this doesnt work when your work provides insurance but I presume yours isnt through work, b/c through work they cannot deny you for pre-exsisting conditions. Just make everything look drastic. For ex, if you have bad heartburn and want an endoscopy done, make sure to say your just starting to have it and exaggerate wayyyy more than it really is. Also dont say anyone in your family has anything either b/c they will look on your forms when you first signed up and say thats pre existing as well. Luckly Obama is gonna end this pre-existing bullshit. Every LEGAL citizen deserves free healthcare in my opinion, so im all for anyone who can try to screw over these greedy corperate insurance scum.

also dont say you take any supplements unless they are FDA approved. Not even protien powder if it isnt fda approved.

[jm425]

Originally Posted by fourthgen

Luckly im on the blue sheild/blue cross Excellus plan which is what most of the corperates are on and few dr's can get on this plan as well. Luckly I had a good connect, but even on this plan, even though pretty much everything is covered, you still always have to ask. First off people think insurance companies are more powerful that they are. You just have to know what to say and what not to say. If you went in now and racked up 10k in bills they have to pay they're % even if its the first day. But they will try everything they can to burn you b/c they are all scum so just make sure to never say anything is pre existing. If you go in for heartburn, just say you started getting it the first day you were insured b/c there's a chance they could say "well you never put you had heartburn down when you first signed up so its pre existing" Now this doesnt work when your work provides insurance but I presume yours isnt through work, b/c through work they cannot deny you for pre-exsisting conditions. Just make everything look drastic. For ex, if you have bad heartburn and want an endoscopy done, make sure to say your just starting to have it and exaggerate wayyyy more than it really is. Also dont say anyone in your family has anything either b/c they will look on your forms when you first signed up and say thats pre existing as well. Luckly Obama is gonna end this pre-existing bullshit. Every LEGAL citizen deserves free healthcare in my opinion, so im all for anyone who can try to screw over these greedy corperate insurance scum.

also dont say you take any supplements unless they are FDA approved. Not even protien powder if it isnt fda approved.

Amen to that. Although, I have aetna PPO and my insurance plan is really good about covering my medical bills. My family however has blue shield and what they pay outta pocket is ridiculous even after they cover their percentage.

[grenada]

haha ok. will keep that in mind.

[maldorf]

I think the pre exisitng condition situation differs from state to state. I know that in my state it is only legal to not cover a pre existing condtion if the person was not previously insured while the condition developed. So if you have cancer or that sort of thing and you didnt have insurance before now, they can deny you for a period of up to one year. After that one year they have to cover you. Now if you have always been insured and never had a gap, they can not get out of covering your problem. So when changing from one insurance to another make sure that you do not have any gaps in coverage.

[maldorf]

I had anthem blue cross/blue shield when i had the heart attack and the bills after it was all done amounted to $80k!!! We had to pay $250, yeah thats right! Two hunderd and fifty bucks, thats it!!!

After my defibrillator was implanted the bills came to $130k !!!This time I had Human and had to pay out of pocket $4k. After meeting this amount, the remainder of the year is covered 100%.

So after it was all done I paid only a little over $4k for about $210k !! If I had anthem bcbs during both events I would have dished out only 500 bucks for the whole ordeal.

[MrDeflation]

Originally Posted by maldorf

I had anthem blue cross/blue shield when i had the heart attack and the bills after it was all done amounted to $80k!!! We had to pay $250, yeah thats right! Two hunderd and fifty bucks, thats it!!!

After my defibrillator was implanted the bills came to $130k !!!This time I had Human and had to pay out of pocket $4k. After meeting this amount, the remainder of the year is covered 100%.

So after it was all done I paid only a little over $4k for about $210k !! If I had anthem bcbs during both events I would have dished out only 500 bucks for the whole ordeal.

I take it you had an HMO?

PPO you would have had coinsurance payment of 30-50% of the total

[maldorf]

Originally Posted by MrDeflation

I take it you had an HMO?

PPO you would have had coinsurance payment of 30-50% of the total

first one was an HMO and the other was what they call POS. That gives you a bit more freedom, dont have to have referrals and that BS. Dont know much about PPOs, but as far as I know all insurance has a maximum out of pocket for the year for an individualy or family. Never seen one that requires you to pay a % copay ad infinitum.

[GoneForever]

Damn you got lucky. If I had to pay even a % of 80k i'd transfer all my $ into a friends bank account and everything outta my name and just say fuck em. Cant deny you any future help, this country is a shithole but at least they cant deny you help.

[crazy_j]

I have BC/BS and have never had any problems at all in the 12 years that I have had it. I have been to the ER several times for all types of things as well as to the doctors for various reasons. The insurance has always covered everything except my copay and deductable. Once your yearly deductable is met you are only left with paying the copays which range in price, but the average is $20.

[Pekkerwood]

I have BC BS and have had one problem over $35 bux that I just paid. Everything else is great. I have 100% coverage after deductible and have never paid a dime. Even when I went out of network they covered it without question. Amazing. They also cover my HRT.