How should I approach this???

[ceecat]

What is the name of your state? CA

I have had kidney stones (4) for about 3 years. I was with Kaiser but due to a move, the nearest hospital was an hour away and we could never get appointments with the doctors here. So, at the beginning of this year, we switched to Blue Shield.

In October/November of last year, we discovered (through Kaiser) that I have 2 kidney stones. I was advised by the Urologist at the time that I didn't necessarily need to have surgery and advised that the worst that could happen is I could develop an infection or blockage. I didn't schedule surgery as a result (but even if I had, it would have most likely been a 3-4 month wait!)

We switched to Blue Shield at the beginning of the year so that we could get access to doctors in this area.

On May 9, I had a kidney stone attack of huge proportions and had to go to the emergency room. Got some Demoral, an MRI and 2 x-rays. Kidney stones are still there.

Now, Blue Shield has sent me a notice saying the billing amount is approx $7,000. and they are inquiring about my prior insurance i.e. Name, policy number, etc.

What am I required to give them as far as information? I gather this would be a pre-existing condition - who will be responsible for payment? Will Blue Shield deny the claim and try to make Kaiser pay for it, or am I going to be refinancing my house to pay for it? I have no idea how to approach this. I've been on medications for the stones, but developed these last two WHILE on medication, so it's a condition that will be ongoing... I can perhaps switch back to Kaiser in October (open enrollment) but would rather not. I have been advised that I should now seek surgery to pulverize the stones, but now will that be covered?? Am I just out of luck as far as Blue Shield paying for this?

Sorry so lengthy - I have no clue what my next steps should be! Thanks for any advice!

 

[cbg]

You are required to give them the information that they ask for. That is, if you want them to pay the claim.

No, BCBS will not be trying to get Kaiser to pay the claim. They know perfectly well that Kaiser has no liability for any claims that take place after the cancellation of the policy.

BCBS is also aware that if you are talking about employer-sponsored group insurance, they MAY NOT consider any condition pre-existing unless there has been a gap of 63 days or more between the end of the old insurance and the beginning of the new insurance, and that even then they can only consider it pre-ex for a limited span of time. To that end, they are attempting to get information about the old policy so that they know whether or not pre-ex applies and if so, for how long.

With only the information available in your post, I can't tell you whether pre-ex applies or not so I can't tell you what BCBS will decide. I CAN tell you that it is in your best interest to cooperate with BCBS and give them the information they ask for.

 

[tammycon]

Easy as pie to handle. Call Kaiser and ask for a certificate of credible coverage for your new insurance company. This certificate shows the timeframe you were covered with Kaiser and is plenty of proof for BC/BS that none of your conditions are pre-existing because you had continuous coverage.