Josh Winter
Expert
- 30
Blue Cross Florida Exclusions & Limitations?
- Thread starter jbage007
- Start date
- 9,744
Tampa. I guess you would call that West Central Florida.
I meant that many pre-authorizations had not been turned down, but I was speaking only of my instances and I should have said that. I did have one turned down, arranged and paid for the test myself, cost me $1450 and told the hospital not to file the claim because the pre-authorization was denied, hospital filed anyway, BC paid it and I received my money back. I just received a bulletin yesterday that starting June 1 all advance imaging, mri's, ct's, etc will need pre-authorization, drug coverages will be changed and a nice rate increase that our OIR approved.
In the instance of the man in the article being denied the claim there are just too many variables. If he did not have creditable coverage going into the new group then yes he had a pre-x that shouldn't have been paid for, but then again if he had not been treated or diagnosed in the six months prior to the effective date of the group coverage it would not have been a pre-x . Depending which plan he had, co-payments to the doc and for drugs are normally paid regardless of pre-x.
He should appeal, call everyday, try and file a complaint with OIR. I say try because I had a client call them two weeks ago and the OIR talked them right out of it, must have been break time in Tallahassee. It seems our OIR has tunnel vision and have their sights set on homeowners rather than the whole insurance industry. I don't think they should have approved the rate increase that they did.
How about a pdf of the exclusions / limitations area of an actual policy?
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What are you getting out of them?
17 and 3?
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