Guaranteed Healthcare

In July, August and September of 2005 I had three procedures associated with internal carotid aneurysms. In July, an angiogram was performed to fully diagnose and plan treatment of the aneurysms. In August, I had surgery to clip three of the aneurysm lobes, then in September I had the coil procedure done to embolize the remaining aneurysm lobes. I was treated by a neurosurgeon and an interventional neuroradiologist from the Department of Neurosurgery at Columbia University (NY Presbyterian system). At the time I was working as a healthcare IT consultant with ACS (originally Superior Consultant Company). As the company was originally based, prior to acquisition by ACS, out of Michigan, the health insurance carrier was Blue Cross/Blue Shield of Michigan. I, however, live in NJ. Living where I do, one would automatically head to Columbia University for any neurological problems -- of course! Whereas my actual hospital bills for these three procedures were paid in full by BC/BS of MI, the coverage of the physician bills has fallen far short. In total, the physician billing for these three procedures was about $120K. BC/BS of MI has paid only 30% of these charges. They used MI rates in making their determination as to what was considered "customary and reasonable" for reimbursement. I was dumbfounded -- I asked how that can be since I live in NJ and would logically seek medical attention of this severity at a major NY medical center. Their continued response has been that the amounts they have reimbured are "reasonable". I have been left with approximately $85K to pay out on my own. In the past three years, I have been able to pay this down so that the total is now about $60K. I try to send money to the physicians every month -- thus far they have been extremely patient and accepting of this arrangement. My own efforts (appeals to BC/BS of MI) and multiple appeals with written justification by the physicians staff have fallen on deaf ears. Recently, I actually received notification from BC/BS of MI that they had "overpaid" on one of the claims -- I now owe them over $2,500. I sent them a check for $50 along with a letter stating that I would try to send them something every month, but also asked for their patience as I was still responsible to pay over $60K on the original physician bills. It was such a shock to me to find this state of affairs with respect to insurance coverage. How naive of me -- I had never been sick, so had no frame of reference. The last time I had been in a hospital was when I gave birth to my daughter over thirty years ago. Does this mean that I no longer incur medical expenses -- YES! I can't afford it.