COBRA/BCBS Denying Coverage
I apologize if this the wrong place to post—please direct me if another sub/tag would be more appropriate.
I was covered by my fiancé’s BCBS (Michigan) plan through her employer as a domestic partner. On 11/1/22, her hours were reduced and we no longer had coverage with that plan and elected for COBRA coverage.
On 11/7/22, I suffered a severe knee injury playing hockey that required surgery and pretty extensive physical therapy afterward. The knee surgery took place on 11/18/22.
We terminated COBRA coverage on 12/31/22, and picked up coverage through another marketplace provider. There was never any lapse in insurance coverage.
Everything that was billed 1/1/23 and beyond seems to be appropriately billed and covered by my new provider without issue, however, there are a mix of bills (primarily in the month of 12/22) that BCBS denied coverage for, and I’m unsure why. The optimistic side of me wants to think this is a billing/paperwork issue that can “easily” be straightened out, but I also have a feeling they will try to stick me with this and something I did (or did not do) is a legitimate reason for them to be able to do this.
The two main items that BCBS is denying that concern/seem strange to me are 1.) Physical therapy visits immediately following surgery (seems like something they should normally provide coverage for). 2.) anesthesia during the surgery, which was billed separately and now has been sent to collections.
It’s also important to note that the ice rink I was injured at insured me through my league and should be my secondary insurance provider, and I believe help pick up some deductibles that are leftover after BCBS covers their end. This paperwork has not been finalized (mainly due to rink management and/or the insurance company dragging their feet).
To summarize, I now have a slew of medical bills—some showing insurance adjustments with a patient balance, others showing coverage was denied by BCBS and the entire balance is entirely mine to cover.
With this information I have a few questions I’m hoping someone/anyone can help shed some light on:
1.) How difficult will it be to straighten out BCBS’s denied claims now that some of these bills has reached collections?
2.) Is it a requirement for my primary insurance provider to contribute to a bill in order for the secondary insurance provider to also step in? Or can one happen without the other?
3.) Is there anything in this situation that blatantly shows I dropped the ball and am SOL that I am missing, or does this seem like it could possibly be a billing issue related to COBRA that I can clean up? (I am prepared for it to be a pain—but am willing to get it done).
4.) Are there any resources or people/specific job titles that are there to provide support through a situation like this? I am not really familiar with anything like this, and to be honest, I am very overwhelmed with the entire situation.
Any insight, advice, or support is welcomed. Just want to have an idea how this could all work out—it’s starting to take a toll on me mentally. Having a hard time determining what the best first step is here.
I spent the last two days compiling all statements, supporting documents, and contact info into a mega spreadsheet, so this has made me feel a little more prepared to tackle this.
Please let me know if I may have left out any information that might be important/required for a post like this to be productive.
