2005-07-27
health insurance fraud???
Recently I have come across a problem with Blue Shield.
My partner, last summer, became 65 years old and ends up being co-covered by Medicare Part A. Last autumn he was hospitalized. Went into the hospital via the emergency room. Stayed overnight but due to tests racked up close to $7,000 in inpatient hospital bills.
Blue Shield provides State Employee Benefits, but I pay extra AND the "unpaid" medical benefits are taxed as "income" [unlike male/female married couples] They initially paid the bill but six months later rescinded payment to the hospital, sending it forward to Medicare arguing that this should be paid by Medicare.
Medicare then refused to pay, saying that it was Blue Shield's responsibility "because they were the primary provider."
Today, by phone, Blue Shield called me at work to tell me that they were under no obligation to pay the costs because Medicare does not recognize the validity of Domestic Partnerships. I was told point blank -at first- that there was no way around this, that since Medicare would not recognize the bill, neither would Blue Cross/Blue Shield. I was told that we are now responsible for paying the full cost of what Medicare doesn't cover for my partner.
I was told that if my partner was under 65, that he would still be covered. Since he is over 65, Blue Shield is under no obligation to honor the bills because "you two are not married."
My response, abruptly, was to ask if what I was being told was that we are not covered because we are a couple of queers. The phone person was silent, the said "I didn't say that" to which I replied, "but the higher ups at Blue Shiled have said it." Her response was, "apparently."
Later, I was told there might be a "carve out" that allows for unconventional dependent arrangement, but the phone worker was unable to tell me how to initiate this.
Does anyone else know of similar situations? If and how they were resolved? ¶ 22:45
My partner, last summer, became 65 years old and ends up being co-covered by Medicare Part A. Last autumn he was hospitalized. Went into the hospital via the emergency room. Stayed overnight but due to tests racked up close to $7,000 in inpatient hospital bills.
Blue Shield provides State Employee Benefits, but I pay extra AND the "unpaid" medical benefits are taxed as "income" [unlike male/female married couples] They initially paid the bill but six months later rescinded payment to the hospital, sending it forward to Medicare arguing that this should be paid by Medicare.
Medicare then refused to pay, saying that it was Blue Shield's responsibility "because they were the primary provider."
Today, by phone, Blue Shield called me at work to tell me that they were under no obligation to pay the costs because Medicare does not recognize the validity of Domestic Partnerships. I was told point blank -at first- that there was no way around this, that since Medicare would not recognize the bill, neither would Blue Cross/Blue Shield. I was told that we are now responsible for paying the full cost of what Medicare doesn't cover for my partner.
I was told that if my partner was under 65, that he would still be covered. Since he is over 65, Blue Shield is under no obligation to honor the bills because "you two are not married."
My response, abruptly, was to ask if what I was being told was that we are not covered because we are a couple of queers. The phone person was silent, the said "I didn't say that" to which I replied, "but the higher ups at Blue Shiled have said it." Her response was, "apparently."
Later, I was told there might be a "carve out" that allows for unconventional dependent arrangement, but the phone worker was unable to tell me how to initiate this.
Does anyone else know of similar situations? If and how they were resolved? ¶ 22:45
