M
marla
Guest
Is there help out there for me? I was going across country from NY to CA last summer to start a new job. I stopped in Wyoming and got bit by a rattlesnake on 8/12. I was covered by BC/BS from my job in NY through 8/31. The health insurance coverage (Aetna) at my new job started on 9/1. BC/BS covered everything regarding the bite ($45,000). I made my way to CA about 1 1/2 weeks later at which time I got severe pneumonia (I aspirated on blood I was throwing up at the time of the bite). I was hospitalized from 8/25-9/5. My new job contacts Aetna and they assign me a case manager because I have to go back to NY for a 2 month recovery period and the case is involved. I have contact with this man in Sept./Oct. of 2000 and he assures me that he will take care of everything. I sent him the BC/BS denial of the medical claims. (BC/BS says they legally have to pay the hospitalization through until 9/5 even though my coverage stopped on 8/31, but they are not required to pay the medical portion of it). The medical charges are about $2000, the hospitalization- $90,000. In November my case manager stops returning my calls so I get my work insurance guy to call him. After months of fooling around the "case manager" says BC/BS should pay all of it. They first said the claims were not being paid because I did not have a referral from a primary care physcian. That of course was impossible because I was in CA for one day prior to hospitalization and not even an Aetna insuree yet. According to BC/BS it is now too late to appeal the BC/BS decision. Who should pay it or am I stuck?? HELP