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Blue Cross wants auto insurance to pay

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:23 AM in Health Insurance Issues
We got a letter today about Dave's ACDF. BCBS seems to think this was caused by an auto accident. It MAY have been, but the accident was 5 years ago!! Unfortunately, he didn't have any symptoms until after the statute of limitations ran out, supposedly--3 years.

Has anyone heard of this??? I thought my car insurance (nofault) was for anything over and above not covered by health insurance. I'm almost afraid to open a can of worms.


  • One time I hit a pothole, which caused my car to bottom out, and I had some whiplash. I went to the doctor a few days later, and then got a letter from my insurance refusing to pay.

    They said that any injury caused in a vehicle must be payed by my vehicle insurance. I was freaked out, because I had never even reported it to my car insurance co as an auto accident.

    Luckily, it was no big deal and they covered it. I would call your auto insurance, ask them about it. If its past the statute of limitations, maybe you can get the two in touch with each other. BCBS may just need proof that its past the statute.

  • Have you ever talked to a lawyer regarding the auto-accident?
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  • We didn't know he had problems until around 4 years later!! I did call one and he told me about the statute of limitations. I would have loved to have sued the jerk who did this, but I guess it's too late.
  • hi davem1652 i am sorry to hear of your ins troubles. i think we all have some sort of ins problem now and then. it sounds like you did not have any medical attention after the auto accident? if that is the case, i think your bcbs ins is tring to look into a crystal ball to past judgements about who pays for coverage for medical attention now. i know it realy sucks when your own medical ins puts u in the middle and the bills go unpaid. also if u started having medical problems about 4 yrs after the auto accident, my guess is your auto ins has settle this case with u and that u might have sign some paperwork to give them a free ticket out of anything in the future. what ever is the case i am sure it is causing u alot of stress and i wish u luck in fineing a solution.
  • dave- don't know if this is the same or not. I had BC years ago. I would occasionally get letters asking me about paying for treatment caused by a 3rd party. It was a form asking me about the accident, attorney name etc. I sent it in and had no more problems. For example, I think BC thought when I said to dr I had an accident and broke my toe that it was caused by someone else. It was caused by me so there is no 3rd party to sue and get money for an injury. I think they are looking for additional insurance coverage as well as any accident settlements so they do not have to pay as much..just a thought..jade
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  • Is really getting bad about not wanting to pay claims. They will try anything to try and get out of paying a claim. If your husband mentioned to the doc that he thought it was due to the accident, it is probably mentioned in the docs notes. Just tell them (BC/BS) that you have no idea if that caused it or not since it took 5 years to manifest. Good luck.
  • Dave -

    I tell you - I honestly do not know how some people can sleep at night!

    The insurance companies do NOT want to come off any of their money, so they will try anything to get someone else to do so.

    If what you received was a questionnaire, that is just standard procedure on any claim they process - just in case they can have another company foot the bill. If it was a specific letter addressed to you - I would think they would first, PROVE your current condition is in fact a result of that one auto accident. I mean, ANYTHING could have caused it - especially since it's taken all this time for conditions and problems to manifest. I would simply write them a letter stating that there is no way to know what caused your condition and that the burden of proof is on them, not you. If this does not work, I would then follow Mazie's excellent and expert advice. The only thing I would add to her post is that in addition to recording date, time, etc., I would also be sure to get the name of the individual you speak with. You could also record the conversation. Just let them know you are recording it because your "memory is not what it used to be" and you don't want to forget something important further down the line. Then watch how their demeanor changes.... :)

    Believe it or not, some people actually believe the insurance companies and take them at their word and do not put up a fight. Think of all the elderly people who have had to pay their bills in full because of this or (God Forbid!) forgo treatment altogether because of these tactics.

    In some cases, a letter should suffice. I'd start there; if that does not work, then follow up with all those other suggestions.

    Good luck to you. What ever you do - do NOT give up. Keep us posted so we can all say "YAY" when they decide it's in their best interest to go on and pay that bill.... ;-)

  • I would contact your state's insurance regulatory agency, every state has one that regulates how insurance companies operate and they will have resources and maybe even an ombudsman that may work in your behalf.

    I can tell you that when the state steps in, insurance company attitudes will change quickly.
  • Sorry you are going through this. It is bad enough dealing with back issues, let alone dealing with insurance companies.... I had to fight BCBS to have bills paid for surgeries already performed myself, and wound up having to get really tough with them. Things should follow through in this order

    1) A denial from your auto insurance company should be cause for BCBS to pay for surgery. If not....

    2) Send a letter from your doctor to the VP of customer service with a copy of your denial telling them you need the surgery and you will go to your State Board of Banking and Insurance with a complaint. First be sure this is where complaints in your state should be addressed, also...

    3) Any and all phone calls you make to BCBS and your auto ins should be directed to a supervisor and you should document the date and time of the call, and what the outcome was...

    4) If you still have no results you can illicit your local state congressman, your state Senator, and your Governor's office to help you with BCBS issues. They have people who help handle insurance issues working in their offices. They can be of great assistance.

    Hopefully you will not need to go this far before you get your issue resolved. I had a big mess between auto/BCBS because it took close to 4yrs for my auto insurer to deny the claim. I had close to $100,000 in medical bills for 3 spine surgeries. I had to fax the VP of Horizon BCBS 50+ pages of denied claims, send the same to the my Senator, Govenor and state senator. BCBS paid everything. The more proactive you are in these things, the more you can accomplish. I learned quite a bit from that experience.

    If you have any questions, need any help send me a pm.

    Good Luck...
    Fused L2-3 to S1 and at C5-6. I have a central herniation @ T11-12 and multiple bulging discs in my thoracic. I also have fibromyalgia and suspected arachnoiditis, awaiting my results of a recent MRI.
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