Battle with the health insurance company

[Bummer Knees]

The settlement was last year with work comp.

I received a rating on the left knee only with a cash settlement on that knee and very small MSA fund set up.

THe right knee and lumbar spine were also a part of the claim but according to the work comp doctor the muscle strain was resolved with no rating given.

Recently I have received treatment for the lumbar spine, ESI injections.
MRI, primary visit, and visit with the neurosurgeon, diagnosis of the spine is DDD.

Received the summary of bills from the health insurance company and they are denying paying for any treatment related to the back due to being work comp related.

I called other party libality with the insurance company about this and complained. Seems they have decided to do an investigation on the lumbar spine and if it is work comp related.

A year ago when I settled I sent the settlement papers to the health insurance company. Their words then, if you did not receive a cash settlement for the knee and back you will be covered by health insurance.

So now I wait with a bunch of unpaid bills.

[bodybuilder1958]

Bummer I know the facility that you used for your ESI quite well and frankly I'm surprised. Usually before the procedure they make sure they will be paid and that insurance will cover minus the co-pays.

Time to talk to the family lawyer and let them handle the BCBS.

Didn't BCBS cover this in the past?

[Bummer Knees]

Yes it has beencovered in the past.

Part of the problem is the individual at the surgery center called me after the injection demanding this is work comp related. I explained to her it was not and she would not listen to me. I am sure she caused the problems with the insurance company. Once this is over I will have her job!

When I settled with wc I sent the settlement papers to BCBS. I was told at that time the back & Right knee would be covered, I have the person's name, date I spoke to them, and a copy of the paper work, and transmital receipt per the fax of paper work I sent them.

The insurance company called today while I was away from the phone, Monday I will learn if they will pay the bills.
If they do not I will hire an attorney. I have been honest and up front with the insurance company, do not know what else I can do.

[Bummer Knees]

Talked to the insurance company yesterday, they were going to deny all bills on the back & right knee.

I told the insurance rep, a year ago I sent you settlement papers, at that time you did an investigation and the outcome was the back and right knee would be covered by health insurance. Now your telling me they are not covered a year later, what is going on here.

THe rep said will your fiel was not updated, I will continue the investigation and get back with you......today they called and the bills will be paid to date with the file updated.

Not a guarantee for the future, if there is any medical not related to DDD or DJD it will not be covered.

They can not get it thru their thick heads I did not receive a rating or settlement on the right knee or lumbar spine.