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Thread: Blue Shield Denies over childhood scoliosis

  1. #1
    Join Date
    Oct 2006
    Posts
    1

    Blue Shield Denies over childhood scoliosis

    After moving to California I applied for new Health Insurance with Blue Shield locally. A few days ago I received a call asking for more information about my scoliosis which I have always been told was moderate only. I answered the questions explaining that I never really feel back pain unless I do something strenuous like run a marathon, and that I run, swim and do pilates and yoga every week.

    Today I was so upset to receive a letter denying my insurance due to scoliosis and very low allergies (like I am told that allergic to my 2 cats that sleep with me every night). Nothing is debilitating. I am 31 years old in perfect health throughout my life, low but healthy weight, and, aside from people telling me I had it and the brace that shamed me through adolescence, I did not ever feel scoliosis. Still, insurance denied me but refered me to a major risk medical insurance program. Risk of what? I have had scoliosis since I was 11 and my curve has actually gotten slightly better with all that pilates - 26 and 28 degrees make the S curve. As a child I asked my doctor to get surgery so I wouldnt have to be braced, but he explained that I was not serious enough. My husband is in law school and I am attempting to bring this issue to the legal clinic. This is stunning to me. Any one else with this kind of experience?

  2. #2
    Join Date
    Oct 2003
    Location
    Utah
    Posts
    1,010
    Just wondering if this is a lesson in non-disclosure. Would it be better to NOT state the scoliosis (because you haven't been treated for it recently, it is not causing any medical conditions, etc., etc., etc.) than to list it? What are the risks of not listing the scoliosis as a previous medical condition?
    Carmell
    mom to Kara, idiopathic scoliosis, Blake 19, GERD and Braydon 14, VACTERL, GERD, DGE, VEPTR #137, thoracic insufficiency, rib anomalies, congenital scoliosis, missing coccyx, fatty filum/TC, anal stenosis, horseshoe kidney, dbl ureter in left kidney, ureterocele, kidney reflux, neurogenic bladder, bilateral hip dysplasia, right leg/foot dyplasia, tibial torsion, clubfoot with 8 toes, pes cavus, single umblilical artery, etc. http://carmellb-ivil.tripod.com/myfamily/

  3. #3
    Join Date
    Sep 2003
    Location
    Fernley, Nevada
    Posts
    352
    ebrooksp,
    I agree with Carmell, that silence would have been the better part of valor. I don't think anyone would tell you to lie, but since you don't have any problems with your scoli, I personally would not have brought it up, or the allergies even. After 20 years in working in hospitals as Dir. of Quality Assurance, I never even told my employers about my scoli.

    I would really fight the insurance company, because this very well may come back to haunt you. If this becomes part of your "history", and you change insurance co's. it is very possible that this info will be passed along, thus making it very, very difficult to get insurance at a decent $$. Good Luck
    SandyC

  4. #4
    Join Date
    Oct 2006
    Location
    Middlebury, CT
    Posts
    15

    It can happen

    I too was denied group health insurance coverage years ago due to my scoliosis surgery - I explained to the compnay that I had had my surgery years ago (i had surgery in 1975 and this was in 1988) - despite sending them a letter from my doctor, I was still denied coverage, and the company i worked for had to get me coverage through another insurer.

    Since then, I have always disclosed the surgery and have never had any problems. What you may consider doing is calling or get in touch with the state department of insurance ( the department that oversees insurance) and find out from them if in fact you are eligible for being denied coverage - I am in CT so am unfamiliar with CA regulations and they vary from state to state. Perhaps the state can help you out.

    just so you know - insurance companies are ALWAYS trying to find a way to not pay out - why just a few months ago they denied payment on my daughter's claim for strepp citing it was a (get this) a pre-existing condition! (I finally got them to pay the bill)

    I wish you luck in fighting the insurance co - but it can be done!

  5. #5
    Join Date
    Oct 2006
    Posts
    2

    Currently Fighting Blue Shield

    I am on a rampage against Blue Shield and I suggest you join the fight. My story is a bit different however, but the outcome will be the same unless people actually fight back. My 10-month old son, he's a twin, was diagnosed with kyphoscolios at about 6 months of age. I am with Motion Picture insurance and they contracted with Blue Cross at this time. I followed the "regulations" and finally found a doctor I trust at Children's Hospital of Los Angeles. We took Ryder to see Dr. Skaggs on July 31, 2006 but on August 1, 2006 Motion Picture switched us from Blue Cross to Blue Shield who claims to have the largest network of doctors BUT DOESN'T CONTRACT WITH THE DOCTORS AT CHILDRENS HOSPITAL because they don't want to pay what that doctors are asking. Everyone else contracts with Children's because it's the largest and best hospital for kids but Blue Shield puts money before members and refuses to negotiate. They receive a letter from me daily and I'm in the process of getting the word out via newspapers and television. Dateline just did a story about this sort of thing, talking about denying coverage and refusing to pay and I've gotten in touch with someone at the network. My husband and I both work for the studios, along with everyone who lives in our community, so we're trying to utilize this to our benefit. Like I told Blue Shield in one of my many letters, I can't afford to fight you in the court system, but I can fight you in the forum of public opinion and I guarentee I'll win! So you can spend millions of dollars on those stupid commericials claiming that you are the best, but one Dateline report and a few newspaper editorials and you're screwed!

    Here's the info...write letters and call daily!

    Blue Shield of CA
    PO Box 292540
    Chico, CA 95927
    (800)219-0030

    I always send a copy to corporate as well
    Blue Shield Corp.
    50 Beale St.
    San Francisco, CA 94105
    (415)229-5000

    It's a pain but don't give up!

  6. #6
    Join Date
    Mar 2007
    Posts
    105
    I know this post is late (just joined recently)... I was denied by Blue Shield as well. I had to put scoliosis on there just because I was prescribed physical therapy for it and they knew or something. But I didn't put that I had pain or anything else. I have a very mild curve (20ish degrees) am only 22 years old no bracing/surgery was ever recommended or offered to me because the curve was so mild. But they turned me down as well.

    So instead I got student health insurance where they cover you automatically no questions asked with Blue Cross.

  7. #7
    Join Date
    Mar 2005
    Location
    east coast
    Posts
    359
    What insurance did you have before? some companies let you 'transfer' over to your new state...
    30 something y.o.

    2003 - T45, L???
    2005 - T50, L31
    bunch of measurements between...

    2011 - T60, L32
    2013 - T68, L?

    Posterior Fusion Sept 2014 -- T3 - L3
    Post - op curve ~35



  8. #8
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,802
    Quote Originally Posted by Carmell
    Just wondering if this is a lesson in non-disclosure. Would it be better to NOT state the scoliosis (because you haven't been treated for it recently, it is not causing any medical conditions, etc., etc., etc.) than to list it? What are the risks of not listing the scoliosis as a previous medical condition?
    A month ago, I would have agreed. However, there have been some news stories in the last few weeks about insurance companies dropping customers and not paying past claims based on the insuree not disclosing something.

    Two words... HEALTHCARE REFORM!!

  9. #9
    Join Date
    Mar 2007
    Posts
    105
    I personally did not have insurance for over a year before I applied for Blue Shield. So technically (at least as I was told by others) they could not list scoliosis as a pre-existing condition or something because I had not been treated for it for over a year. But they denied me anyways.

  10. #10
    Join Date
    Feb 2008
    Posts
    16
    Hello, I know this thread hasn't been used in a while, but, I was just denied health insurance by blue cross today because of my scoliosis. I have had scoliosis for almost my entire life. I was never denied insurance because of it before. I am 49 years old and I had started seeing specialists for my back. I know my back is just getting worse with age, and now I have been turned down because of it. I am nervous. Has anyone else been going through this lately? Any advice?

  11. #11
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757
    While BCBS is usually not too bad on large group policies, they're one of the absolute worst companies about denying coverage and dropping people for the most ridiculous reasons.

    (Personally, I'd never volunteer information about a condition for which I hadn't sought treatment, but that's just my view.)

    True story ... a friend of mine got an individual family policy through BCBS of Texas to cover herself, her husband, two young children and her 19 year old step-daughter who'd come to live with them from Wisconsin (and was going to college here). She had NO idea the 19 year old had been diagnosed with human papilloma virus before she came to live with them, and therefore didn't disclose it on their application.

    They were approved, BCBS took their payments for a few months, and one day she received a letter the entire family had been dropped (like 3 weeks before BCBS got around to notifying her) because they discovered the HPV diagnosis my friend didn't even know about.

    They wouldn't even let her reapply if she excluded the 19 year old from the policy. There was absolutely nothing she could do.

    The system is seriously, SERIOUSLY broken.

    Pam
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

  12. #12
    Join Date
    Jun 2005
    Location
    Bloomfield Hills, Michigan
    Posts
    285
    For whatever it's worth, I have had BCBS insurance for all of my surgeries, the first three under two different companies' group coverage and the last one under an independent conversion policy. There were no waiting periods and never a question about coverage.

    That being said, I have enough OTHER horror stories about insurance so I agree that some sort of reform is necessary. However, I live in Michigan, right across the river from Canada, so I meet lots of Canadians working in the U.S. just to get our insurance coverage. I hear lots of anecdotal stories about Canada's health system that makes me cautious about any potential universal system that might be instituted here. Not criticizing my dear Canadian friends ... just mentioning what I have heard over the years.
    FeliciaFeliciaFelicia
    10/24/00 posterior fusion T4-L4 at age 57
    8/5/05 posterior surgery for spinal stenosis at L4-L5; laminectomy and fusion
    5/14/07 posterior revision with fusion to sacrum
    2/11/08 anterior discectomy L5-S1, and reinforcement of fusion with plate attached to L5-S1
    3/9/2011 and 3/11/2011 revision surgery with Dr. Lenke, St. Louis - complete revision and fusion with instrumentation from T1 to sacrum, one lumbar osteotomy.

  13. #13
    Join Date
    Sep 2003
    Location
    NJ
    Posts
    1,291

    Insurance coverage

    The practice of denying insurance coverage because of even the most minor ailment, is called "cherry picking" in the industry. The insurance company wants to eliminate payouts. Usually, group coverage by an employer eliminates these impediments. Also, if a person drops COBRA, and then tries to get on another plan then the insurance companies have the right to ask these questions. If COBRA is maintained and then a switch to a new plan is is necessary health questions are usually not required. Easier said than done.
    Contacting the state insurance dept. seems like a good idea.
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

  14. #14
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757
    FFF, I've missed you. And I know what day the 11th was, doll. ;-)

    Love ya,
    Pam
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

  15. #15
    Join Date
    Sep 2008
    Posts
    336
    Are any of you finding this with your children who need the surgery?

    My dh's employer changed insurance companies Jan. 1. I've been bugging dh to find out if dd's surgery will be covered, will we have to go through the hassle of getting another opinion (although the dr. we have is covered under the new insurance--he wasnt' under the old).

    Marian

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