I have been extremely lucky that I am basically a healthy person. I rarely have used my medical policy from Athem-Blue Cross and basically didn’t give it much thought. I have been with Blue Cross about 20 years and I thought I had fairly good coverage, which I feel I basically do. But during the past six months I have learned a very, very important lesson. Read your policy and know how coverage is provided.
Here is the first clause that I found in my policy that says it all:
Lack of knowledge of, or lack of familiarity with, the information contained in this booklet does not serve as an excuse for noncompliance.
It started with some expensive testing which I had between the months of September to November, 2009. Two of the tests required precertification before the procedure which my doctors had obtained. There was just one small feature of my policy that wasn’t followed. The certification was not obtained 3 business days before the testing. My policy states:
Precertification is required no later than three (3) business days prior to commencement of the procedure, service or surgery.
It is your responsibility, not your provider’s, to call the Review Center. Failure to obtain precertification from the Review Center within the specified time frames will result in increased liability or complete denial if it is determined that the services were not medically necessary or not a covered benefit of thePlan.
Because of this I was charged a penalty. It cost me $391 out of my own pocket.
I spent last evening reading the entire 118 pages of do, don’t and gotcha’s! LOL