I have an individual policy with Blue Cross and Blue Shield. When I first obtained the policy (after a switch in employment), I was given a book showing all of the doctors covered under my policy. I was happy to see that my thearapist was one of them and continued my thearpy with her. After the first session I receieved a letter from BCBS stating that my coverage did not include mental health issues (since I had only an individual policy and not a group policy) so they would not cover my bills. After extensive complaints and appeals they admitted that they sent me the wrong book for my policy which had stated that this doctor was covered by them and I was basically out of luck and ended up having to pay the bill myself. Can an insurance company really deny you mental health coverage? Isn't this a form of discrimination? I can't even see the doctor for depression without them denying my claim. What is wrong with this picture?
2007-08-13 09:10:49 · 9 answers · asked by MelA 2 in Politics & Government ➔ Law & Ethics
Your paragraph raises all sorts of questions.
1. Does the cover on the book they sent say that it's for the group plan, rather than the individual plan?
2. Would the policy cover mental health issues, if you were referred by an in-network generalist to an in-network specialist?
In general, though, you're talking about a private company, so pretty much they can do what they want in terms of what services to offer. You elected to purchase their insurance, so you're stuck with what you purchased, alas.
2007-08-13 09:18:50 · answer #1 · answered by Molly 4 · 1⤊ 0⤋
When you say "switch in employment" did you mean to another company sponsored plan? If so, that IS Group Coverage and not Individual. If you signed up for the coverage on the pretext of the booklet they had sent you, and were then told they provided you with the wrong information, that is "bait and switch" and I would sue in a heart beat. If it is individual insurance there should be some form of Buy Up coverage that would allow you to purchase Mental Health Coverage for an additional fee. However, Blue Cross is a multimillion dollar insurance agency and should not be making mistakes like sending out wrong booklets to their insureds. I would recommend switching carriers if you have the choice.
2016-05-17 04:47:45 · answer #2 · answered by Anonymous · 0⤊ 0⤋
It is very unfortunate that many health plans, including the top known ones, such as Blue Cross & Blue Shield, do have the right not to cover mental health issues.
Yes, I feel that this is discrimination, as I have gone through the same thing. It is difficult enough for someone to find the right therapist to deal with, and then when you do, the majority of the time that doctor is not covered.
I would also like to know why my co-payments for office visits for all doctors are $20 - including specialists, EXCEPT for my mental health providers. My co-payment for that is $40
2007-08-13 09:24:10 · answer #3 · answered by Vera C 6 · 0⤊ 2⤋
The insurance company has the right to change its co verge as long as it notifies you in advance.
If they admitted sending you a document that would reasonably lead you to believe you had coverage that in fact you did not have, you may be able to get your money back.
But it will take a lot of negotiating and probably a lawyer.
The first thing I would do is contact your state's commissioner of Insurance and file a complaint.
2007-08-13 09:23:04 · answer #4 · answered by fredrick z 5 · 0⤊ 2⤋
Not really sure of the legal aspects (need to talk to a lawyer) but check with your state's insurance commission and see if it is state law that mental health is to be treated the same as other illnesses in insurance coverage. Many states have this requirement of carriers of insurance in their states.
2007-08-13 09:23:12 · answer #5 · answered by ALASPADA 6 · 0⤊ 2⤋
What is and is not covered depends on the insurance policy you purchase. They do not have to sell you mental health coverage if they do not want to.
That said, they should cover the one session with your thearapist before they told you he was not covered. It was their mistake. Legally, I do not know of any standard that would force them to do this though.
2007-08-13 09:20:47 · answer #6 · answered by Michael C 7 · 1⤊ 2⤋
Sorry, but they're completely within their rights to change the coverage for different policies. It's not discrimination because they won't cover your therapist.
2007-08-13 09:18:53 · answer #7 · answered by Hillary 6 · 1⤊ 1⤋
Private insurance companies are omnipotent, and regulated by any governmental laws. As a private enterprise than can cover or nor cover whatever they wish or not wish to.
And remember their main concern is to make money for themselves and their shareholders, your obligation is just to send your money to them.
2007-08-13 09:22:16 · answer #8 · answered by Mezmarelda 6 · 1⤊ 1⤋
stop being sue happy
2007-08-13 09:18:07 · answer #9 · answered by Mike T 2 · 1⤊ 4⤋