California Health Insurance/Blue Cross CAPS!
Jeff Zeller
Description
Collection
Title:
California Health Insurance/Blue Cross CAPS!
Creator:
Jeff Zeller
Date:
8/3/2007
Text:
Other California Practitioners,
I have a patient who fits the criteria exactly, for an instance of someone
that Assembly Bill AB- 2012 is supposed to fix. This patient is a brand new
BK amputee. Has a Blue Cross plan that pays 100% in network once $250.00
deductible has been met. Which it has. BUT she has a $1,000.00 per year cap
on DME which she has already used up. She is paying $400.00 per mo. Out of
pocket for premiums, on top of what her employer is paying, and she can't
have a prosthesis, unless she want's to pay entirely out of pocket for her
first prosthesis which she needs.
I called Blue Cross and was told that the law does not apply to this
circumstance because her employer choose to purchase a plan with a $1,000.00
cap on DME and therefore her employer is breaking the law.
I asked to speak to the provider CUSTOMER SERVICE reps supervisor and was
told she will just tell me the same thing. I then asked to speak to, or to
be given the number to the Blue Cross legal department. I was put on hold
for another 15 minutes (this call took 1hr.10min.) I then was told they did
not have a number for their legal department.
This is just an outrage to me. How are new amputees supposed to deal with
the loss of a limb and then be told after paying many dollars out of pocket
for insurance that the insurance won't allow them to have a chance of normal
ambulation.
Anyone else try to put AB-2012 to the test yet? Were you successful? How'd
you do it?
Thank You for your responses.
Jeff A. Zeller, CP
(BK Amputee)
I have a patient who fits the criteria exactly, for an instance of someone
that Assembly Bill AB- 2012 is supposed to fix. This patient is a brand new
BK amputee. Has a Blue Cross plan that pays 100% in network once $250.00
deductible has been met. Which it has. BUT she has a $1,000.00 per year cap
on DME which she has already used up. She is paying $400.00 per mo. Out of
pocket for premiums, on top of what her employer is paying, and she can't
have a prosthesis, unless she want's to pay entirely out of pocket for her
first prosthesis which she needs.
I called Blue Cross and was told that the law does not apply to this
circumstance because her employer choose to purchase a plan with a $1,000.00
cap on DME and therefore her employer is breaking the law.
I asked to speak to the provider CUSTOMER SERVICE reps supervisor and was
told she will just tell me the same thing. I then asked to speak to, or to
be given the number to the Blue Cross legal department. I was put on hold
for another 15 minutes (this call took 1hr.10min.) I then was told they did
not have a number for their legal department.
This is just an outrage to me. How are new amputees supposed to deal with
the loss of a limb and then be told after paying many dollars out of pocket
for insurance that the insurance won't allow them to have a chance of normal
ambulation.
Anyone else try to put AB-2012 to the test yet? Were you successful? How'd
you do it?
Thank You for your responses.
Jeff A. Zeller, CP
(BK Amputee)
Citation
Jeff Zeller, “California Health Insurance/Blue Cross CAPS!,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/228479.
