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View Full Version : Blue Shield Denies over childhood scoliosis



ebrooksp
10-26-2006, 04:48 PM
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?

Carmell
10-26-2006, 05:57 PM
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?

SandyC
10-27-2006, 04:00 PM
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

majose
10-28-2006, 06:18 PM
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!

twinmom
10-29-2006, 01:46 PM
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!

trcylynn
06-22-2007, 06:40 PM
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.

green m&m
06-24-2007, 01:34 AM
What insurance did you have before? some companies let you 'transfer' over to your new state...

LindaRacine
06-24-2007, 01:19 PM
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!!

trcylynn
06-25-2007, 10:17 AM
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.

cameol998
02-05-2009, 08:24 PM
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?

txmarinemom
02-10-2009, 10:13 AM
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

trulyaries
02-11-2009, 09:59 AM
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.

Karen Ocker
02-11-2009, 07:49 PM
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.

txmarinemom
02-12-2009, 01:04 AM
FFF, I've missed you. And I know what day the 11th was, doll. ;-)

Love ya,
Pam

pmsmom
02-12-2009, 06:12 AM
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