US health insurance coverage problem

suarezj519

Member
May 14, 2014
113
0
16
Ok, so I was schedule for gallbladder surgery Tuesday morning (August 1st) but due to not receiving authorization from Blue cross (geo blue) it is delayed and I have some serious pain right now. Clínica Abreu (which is a network partner) has not received any authorization from them and cannot process me. Supposedly I have received authorization for "observation" "or 23 hours but the attendant at the clinic says they do not do that? GeoBlue says they need results and report saying why I need the surgery. The doctor here looked at my US results and they did an ultrasound and blood test. He said there's no point repeating an MRI, HIDA scan or colonoscopy when it is already determined I need surgery. So how can I go about this? Because I assume if they "observe" me they can send the info back to blue cross for surgery authorization correct? But the lady at the clinic is saying they don't do observation which is confusing. I'm in real pain and this is very frustrating. I'm getting DR insurance. But this needs attention now obviously. I don't know who's fault it is right now. They're telling me right to just scrape up the money (5k us) which I don't have and just get. It reimbursed. This is very frustrating.
 

SKY

Gold
Apr 11, 2004
9,959
269
83
Blue Cross is one of the worst companies there is. I had coverage with them many years ago and they had some "nurse" call me and tell me I have to leave the hospital after a serious surgery. The Doctor said I cannot leave yet. Well in the end they refused to pay the entire bill.

I had a good lawyer who went after them and made them pay.

I would never use them for anything.
 

suarezj519

Member
May 14, 2014
113
0
16
Blue Cross is one of the worst companies there is. I had coverage with them many years ago and they had some "nurse" call me and tell me I have to leave the hospital after a serious surgery. The Doctor said I cannot leave yet. Well in the end they refused to pay the entire bill.

I had a good lawyer who went after them and made them pay.

I would never use them for anything.
I know they are bad, but right now it's the only option I have. DR insurance won't kick in for a couple months and currently we re resolving this. Should I seek legal action if this does turn out like this? It says clearly on their page that clínica abreu is a in-network provider for direct billing. I find it hard to believe that no one has had a similar experience with this.
 

SKY

Gold
Apr 11, 2004
9,959
269
83
You can seek immediate legal help. If you have or know a lawyer that could call them and threaten them with a law suit if they do not take action on this right now . Nothing to lose. You could well die if they deny this.
 

keepcoming

Silver
May 25, 2011
2,790
52
48
Does your policy cover out of country services? Is it just on a emergency basis (life threatening)?. Because you had a work-up prior to all this in the US are they considering this as "elective" surgery? I doubt that the DR has the Observation vs Inpatient process (basically billing/charges issue). Using insurance out of country can be tricky. Go over your policy to see what exactly is your out of country benefit. And yes Blue Cross is a pain in the a**
 

ExDR

Member
Jul 31, 2014
421
0
16
Maybe you can get a flight to Puerto Rico and get the surgery there. If the pain is unbearable until BC/BS get their head out of their azz.
 

LTSteve

Gold
Jul 9, 2010
5,450
20
38
Ok, so I was schedule for gallbladder surgery Tuesday morning (August 1st) but due to not receiving authorization from Blue cross (geo blue) it is delayed and I have some serious pain right now. Clínica Abreu (which is a network partner) has not received any authorization from them and cannot process me. Supposedly I have received authorization for "observation" "or 23 hours but the attendant at the clinic says they do not do that? GeoBlue says they need results and report saying why I need the surgery. The doctor here looked at my US results and they did an ultrasound and blood test. He said there's no point repeating an MRI, HIDA scan or colonoscopy when it is already determined I need surgery. So how can I go about this? Because I assume if they "observe" me they can send the info back to blue cross for surgery authorization correct? But the lady at the clinic is saying they don't do observation which is confusing. I'm in real pain and this is very frustrating. I'm getting DR insurance. But this needs attention now obviously. I don't know who's fault it is right now. They're telling me right to just scrape up the money (5k us) which I don't have and just get. It reimbursed. This is very frustrating.
Call Blue Cross and find out what the problem is. Talk directly to a someone and explain the situation and find out why? Asking us for info is wasting your time.
 

dv8

Gold
Sep 27, 2006
31,271
359
0
is is possible for you to fly back to the states and would the surgery be covered there?
if you have no money and the situation is critical (that is that you will die without the surgery) then call 911 and risk public hospital.
 

suarezj519

Member
May 14, 2014
113
0
16
Well, obviously since I am writing this the pain is bearable and not like it has been at times. Right now I got the authorization for surgery and observation (good news). Bad news is now the clinic is saying I have to pay the deductible that I have upfront to them... So now I'm in a bind right now and seeing if I can scrape up the cash.
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,966
920
113
Well, obviously since I am writing this the pain is bearable and not like it has been at times. Right now I got the authorization for surgery and observation (good news). Bad news is now the clinic is saying I have to pay the deductible that I have upfront to them... So now I'm in a bind right now and seeing if I can scrape up the cash.
Did you ask your dad?
 

keepcoming

Silver
May 25, 2011
2,790
52
48
Watch the "observation" approval. I still seriously doubt the DR has those kind of billing options (revenue codes). In all seriousness if you can go back to the US to have the procedure, you should.