Summary of Benefits vs. Policy language

RE: Summary of Benefits vs. Policy language

CCJP — Wed, 18 Feb 2015 22:39:34 GMT

I have sent in my appeals (appealing the deductible applied to a diagnostic service and an outpatient surgery- if you have Blue Precision Gold HMO 001, you will see in the policy booklet that these shouldn't have deductible applied to it) and still have not received answers. There is still quite a discrepancy between the Summary of Benefits and my Policy booklet. I have a deductible. We all know it applies to some things and not others, right? So, how do we find out what it applies to and what it doesn't? You read your booklet, right? Well, I have read my booklet. I have noticed that IT WILL STATE WHEN DEDUCTIBLE APPLIES. When it does not, it simply states "No charge, none, or 100% (coverage)". If I cannot rely on this language- what can I rely on???? Either my appeal was denied erroneously, or the policy booklet needs to be re-written. I even said this in my appeal- but it was not responded to in nuance, the way that I detailed my argument- it just gave me a blanket statement that I have a deductible, which was not met, therefore I owe it. NO response to the stipulations listed in my booklet. REALLY?!

RE: Summary of Benefits vs. Policy language

John Sample — Mon, 02 Feb 2015 10:33:49 GMT

I have had a policy with BCBS for a long time with my son on the policy. He just got a job that offers insurance. If he goes off of my plan, but then later gets put back on my plan will it effect my policy. It is an older grandfathered policy.

RE: Summary of Benefits vs. Policy language

BCBSIL Connect Team — Thu, 08 Jan 2015 08:49:46 GMT

Great! I will get that over to one of my team members who will review your information.
Thanks!

RE: Summary of Benefits vs. Policy language

CCJP — Wed, 07 Jan 2015 21:28:52 GMT

I just sent a private mention, with attn to Tonya

RE: Summary of Benefits vs. Policy language

BCBSIL Connect Team — Wed, 07 Jan 2015 13:03:48 GMT

Good question! This is public. To send us a private message, you can click on the envelope at the top right of the page and send us a message. --Tonya

RE: Summary of Benefits vs. Policy language

CCJP — Tue, 06 Jan 2015 21:14:49 GMT

I would be happy to- but is this public? Or is this just a private message between your team and me?

RE: Summary of Benefits vs. Policy language

BCBSIL Connect Team — Tue, 06 Jan 2015 16:28:36 GMT

Hmm- we'd have to take a closer look at the claims to see exactly what's happening. Would you mind providing us with your policy ID and contact information? Any claim details you could provide would also be helpful. We can reach out to you to discuss. Please make sure you send your information via private message. Your privacy is very important to us. --Tonya