Can’t believe the way BCBSIL treated patient!

I received a $5000 bill from the hospital in Sep 2022 because the BCBSIL refused to cover a procedure I had done in June 2021. I paid $8000 in 2021 to meet the out-of-pocket line already, and now they won't cover what they're supposed to.

I submitted my appeal materials with the insurance on Nov 10th, 2022, including sending them my doctor's letter to prove the procedure was necessary. And I called them on Nov 25th, 2022, to make sure that they’ve already received my appeals on Nov 17th, 2022.

However, after two months of waiting with the hospital called me nonstop, I contacted the BCBSIL and found out the appeal has not even been initialed. The reason they gave me is "someone must have forgotten to initial your appeal". It's so unacceptable that they could be so careless and disregardful, causing me needless stress and frustration.

Finally, on Feb 01, 2023, I received a denial letter which claimed my doctor asked for a procedure for my "ulcerative colitis", which is NOT even my condition! I was actually diagnosed with "Crohn’s disease". When I reached out to their appeal department, they didn't bother responding to my first email. In the second email they told me I’ve used up all my internal appeal chances, without any explanation or apology for the mistake. And in the third email, they simply send me another denial letter with the only change being the substitution of 'Crohn’s disease' for 'ulcerative colitis', while every other word remained exactly the same!

I'm beyond furious that the BCBSIL appeal specialist didn't bother to read my medical materials or take my condition seriously. It's a complete waste of time and appeal chances because they’ll deny your appeal anyway.

I'm currently filing an external appeal, hoping that someone out of their broken system will overturn the denial and cover the claim. But I feel helpless and unsure about what else I can do to protect my rights as a patient. Have any of you been in a similar situation? How did you fight for your rights? Any advice would be greatly appreciated. Thank you!

submitted by /u/little_watermelon_X
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