One of their in-house "doctors," sitting in some office in Austin, decided that my own doctors shouldn't have sent me to the hospital.
We had a similar situation with BCBS Ohio. MrsTasty was having a problem, and we called the BCBS nurse practitioner, who referred us to the emergency room.
Once we got to the ER and the doc there figured out what was going on, BCBS declined to pay for the visit, which was $3800. Their rationale was the same, that she shouldn't have been referred to the ER, because it turned out not to be an emergency.
Well, first, sometimes you don't know until you go and second, YOUR DAMM NURSE WAS THE ONE WHO REFERRED US!
They ended up paying the majority of it. We still had to cover $700.
When MrsTasty has her heart attack, the doctor recommended inserting a long-term loop recorder and needed a decision right then to do it (that's another story concerning that quack). She added that the device, procedure, and monitoring were hellaciously expensive and gave me about 20 minutes to call my insurance to make sure it was covered.
What'd insurance do? Sent a hundreds-of-pages-long PDF to my phone, told me to look it up in there, but really, they'd make a determination once the hospital submitted the charge, so maybe it would be, maybe it wouldn't. Thankfully, it was, but that's no way to do business - "get the procedure done and we'll see."
The worst part...I've had Medical Mutual, Humana, Anthem, and a host of other coverage over the years and BCBS Ohio is by far the best. That's just sad.
(I like the rain).
