ConsumerWatch: Blue Shield Customer Gets $5K Bill Reversed

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PALO ALTO, CA (CBS) – A Palo Alto couple has just won their battle with Blue Shield over a $5,000 medical bill.  

John Whitin said Blue Shield sent him to collections asking him to return the money that it had originally paid out for a colonoscopy procedure for his wife. The procedure was supposed to be a covered benefit and was recommended by her doctor. 

Whitin said Blue Shield told him a colonoscopy is only covered for individuals ages 50 to 70. Whitin’s wife was 48 years old at the time. According to insurance advocate Doug Heller with Consumer Watchdog, California law dictates the insurer cannot rescind or modify authorizations after the provider renders the health care service. It’s illegal to ask for the money back.

Patients can be denied coverage for two reasons, according to insurance advocate Robert Jetter with America’s Health Team. One, it’s not medically necessary as deemed by the doctor and two, it’s not a covered benefit.

Whitin finally contacted CBS 5 ConsumerWatch. The charges were dropped after a ConsumerWatch volunteer contacted the Blue Shield. The insurer blamed the problem on a clerical error and said it was already looking into the case.    

Health care experts suggest it’s a good idea to get a pre-authorization before any procedure is preformed.  Patients also have the right to an independent review panel if denied.  

If you have a problem you’d like ConsumerWatch to know about, call our volunteers at 888-5-HELPS-U (888-543-5778) or email us at [email protected].

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