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May. 2nd, 2005 @ 08:16 pm BlueCross BlueShield of Florida!
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Well, as long as it doesn't cost them too much!

So those that have been following along, 8 years ago I had back surgery at L4&L5. A year later I switched to BlueCross Blue Shield of Florida, and a two year rider was placed on it for any medical treatment involving my back, and this rider would be effective for 2 years.

That was fair.

I spent several days deciding whether it was worth the risk to switch to a better insurance provider, because after all, many times back troubles return.

I felt good though.

Strong. Two years seemed a reasonable amount of time for me to wait if anything did happen to my back, meaning I was well aware anything within two years was not covered and would come from my pocket.

I built a rather large house by myself in the past five years, which incidently was the time my two year rider expired.

I roll a truck at 60 mph a few times, rupture 4 disks in my neck and back, go in for preapproved MRI's, then they decide oh wait, we can get out of this because he forgot to dot an I seven years ago.

This is the letter they sent me.

If you think they are right, by all means, feel free to stick up for them.

If you have a rider on your own policy that had a time limit, you better be calling your agent, because if you look at the letter they wrote, ALL riders are forever, unless of course you ask them very nicely.

The most ludicrous part of this all is that since they are the ones that get to see EVERY SINGLE CLAIM FROM EVERY SINGLE DOCTOR I HAVE EVER BEEN TO IN THE PAST 7 YEARS, they know very well that my neck injuries are not at all related to my lower back, and even if they were, the times up.

Their letter follows and it's uploaded to four servers. The letter is my property once the US mail delivered it to me, and I should be legally able to post a scanned image of it. If I'm not then the Laws are wrong.

PS: I am so torked up about this I'll probobly stay up late enough to watch Leno or Letterman.

I think someone was going to be on Letterman I wanted to see, so I won't at least waste this newfound energy...

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About this Entry
[User Picture Icon]
Date:May 3rd, 2005 02:22 am (UTC)
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Hrm...do you have the original rider paperwork perhaps with a cover letter? It might be worth looking into if there is a conflict in the wording.
[User Picture Icon]
Date:May 3rd, 2005 01:52 pm (UTC)

I thought posting Ms. Burdick's Phone number might be more effective

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Just a though..........
[User Picture Icon]
Date:May 3rd, 2005 04:14 pm (UTC)

Re: I thought posting Ms. Burdick's Phone number might be more effective

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I disagree. She's asserting that they are following the policy rider they issued. This is a legal issue, not one where a few phone calls will tip the scales in your favor.

I'm curious to see whether they actually *are* following their wording. Because if they *aren't*? THAT has the potential to a) be actionable and b) make them take care of it in a hurry lest they look very bad, very publicly.

If there is a conflict between a letter and a printed rider contract, the letter also ~might~ legally override the contract. (IIRC from my business law course, wording that is thought to be newer is given more weight; thus typed changes override preprinted ones and handwritten changes override typed ones.)

Since it had to cover a period of more than one year, whatever was stated has to be in writing; any conflicting information that you might have been told (orally) would not count.

Do you see where I'm going with this? (And it doesn't mean there IS a conflict between what the letter/contract says and what she has stated, in which case you are probably SOL, but it's worth checking.)
[User Picture Icon]
Date:May 3rd, 2005 05:20 pm (UTC)

Can you SUE an HMO or PPO?

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LOL, maybe for breach of contract or something and yes, I understand exactly what you are saying but how stupid do thing have to get?

How Ironic would it be if I needed to hire another attorney?
[User Picture Icon]
Date:May 3rd, 2005 07:51 pm (UTC)

Re: Can you SUE an HMO or PPO?

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how stupid do thing have to get?

You don't really need me to answer that, do you? :)
Date:May 3rd, 2005 02:24 am (UTC)
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aaarrrgh!!! so damn frustrating!
[User Picture Icon]
Date:May 3rd, 2005 01:55 pm (UTC)

You'll laugh at this one...

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I was talking early this morning to a neighbor and mentioned the BlueCross thing and he told me a similar ludicrous story..

When he was in the military, he was injured in an explosion, and some of the fallout of that situation was he suffered some hearing loss.

The VA determined that his right ear was in fact damaged by the blast, and they would therefore cover any treatment to it, but his left ear was too far away for it to have been affected, so that wasn't their fault.

Date:May 3rd, 2005 07:40 pm (UTC)

Re: You'll laugh at this one...

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wha? what kind of screwed up logic is that crap?!
[User Picture Icon]
Date:May 5th, 2005 11:10 pm (UTC)

That's called

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Military Intelligence!