MAJOR GRIEVANCE

Man, O MAN! Is dealing with medical issues a PART-TIME job, or WHAT?!!! Yesterday I spent the entire morning talking to insurance people, my doctors, their nurses, and Apria medical suppliers just to get crutches and a wheelchair delivered.

Today I spent the entire morning dealing with this giant bucket of BS:

August 29, 2006

ATTN: GRIEVANCE
Empire BlueCross BlueShield HMO
PO Box 1407 Church Street Station
New York, NY 10008-1407

RE: Grievance for Physical Therapy

Dear Sir or Madam:

On December 15, 2005 I had major surgery to remove bone cancer (chondrosarcoma) from my left femur at Memorial Sloan Kettering Cancer Center, under the care of Dr. John Healey. Since this surgery involved resecting and reimplanting 23cm of my femur and caused major trauma to my knee and the musculature of my left leg, I have required physical therapy over the months.

When I was in New York City, receiving physical therapy at MSKCC, all my sessions were covered. I never had to personally phone in for pre-authorization.

I applied for Away From Home Care Guest Membership in May, to maintain my coverage in both Denver and New York City. In July I was told by Dr. Healey that I could increase my weight-bearing and after seven months on crutches to move to a cane in hopes of learning to walk again without assistance. I needed a physical therapist once again.

I called the number on my Away From Home Care Guest Membership card to ask about coverage for physical therapy in Denver, and the woman assured me that I had 20 sessions covered.

I paid my co-payment of $10 for each session. Suddenly, today, I received a bill for $420 for three of my physical therapy sessions at Denver Physical Therapy, which I picked specifically because it was on the list of covered providers. I have five other sessions that I have not yet been billed for as well.

I am really at a loss as to why I am being billed. I called customer service and the nice woman I spoke to explained that I had needed pre-authorization. I hope you can understand that I didn’t know that Denver Physical Therapy had failed to do so, like my physical therapist at MSKCC had done—I thought that was the procedure. It was my understanding that by providing my insurance information to DPT and by calling HMO Colorado ahead of time to ensure I had sessions available to me, that I was covered.

I have been a member of Empire BlueCross for three years. This is the first complication I have had in my coverage, which I believe is due to the changes of moving and of applying for guest membership and of miscommunication. I am asking you to please understand and to provide a one-time courtesy and cover all the claims for physical therapy from Denver Physical Therapy. If you require more information from my surgeon or past or current physical therapists to explain the nature of my case and how therapy is needed to help me walk again, I am happy to provide that. I’m just a 29-year-old hoping to walk without a limp again! Thank you so much!