• Insurance Carrier: Blue Cross Blue Shield / Passport (kma)
  • State: KY

Consumer Complaint:

My wife and I had with a lack of claims payment from our Health Insurance carriers. We adopted a son in 1999 through the KY CHFS SNAP program. Our son was referred to the Bingham Child Guidance Clinic for behavioral counseling and received periodic treatment from 1999-2005. Our insurance coverage was / is: (1) KMA / Passport — Covers 100% of \”mental health specialist visits\” once other insurance is applied; (2) Blue Cross Blue Shield (through work)– Covers 100% of In-Network mental health services and a lesser percentage Out-of-Network. Appropriate referrals for our son to be treated at the Bingham Clinic were sought and approved, and insurance benefits were provided for treatment. Later, BCBS declined to provide coverage, and Passport in turn refused coverage since the primary coverage wasn’t accounted for. There arose an unpaid bill of $3,777.67. We ultimately ceased our son’s visits with the Bingham Clinic. We have recently been served with a bill from a collections agency for the unpaid balance of the Bingham Clinic charges. We believe that we are being denied the proper insurance coverage for our son. As a result, we are seeking any assistance and/or advice that anyone can provide us with.

Insurance Expert Answer:

First, you have to know WHY the primary carrier denied benefits. You are entitled to a written explanation. If you don't have one ask for one. Second, you often have to appeal any denial of benefits within the carrier under a strict time limit. If you have not done so, try to do it now. Third, secondary carriers typically won't pay unless the primary has paid. That sometimes makes sense but often does not. Yet that's the way the policies are written, and you're usually not entitled to more than what the policy promises. So usually you work on getting the primary to pay and then double back to the secondary. Finally, this involves so many facts and circumstances and policy provisions that unfortunately we can't help any more.