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Topic: Insurance Cancellation Hor BC/BS NJ

Forum: Advocacy — Join here to discuss issues where we can have a voice!

Posted on: Apr 13, 2012 06:40AM

NancyNJ wrote:

Has anyone had a problem with threatened policy cancellation from Horizon BC/BS NJ?  After submitted bills for two mastectomy's, a DIEP Flap that failed, Hospital infection, nurses at home for months etc..etc...etc.....we were"randomly" audited and they've asked for one piece of documentation after another and nothing - nothing seems to satisfy them. Has anyone dealt with anything like this that can offer any support or guidance?

Dx 12/1/2008, DCIS, 2cm, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Apr 13, 2012 06:52AM Soccermom4force wrote:

Contact these folks ...


They've helped me navigate the insurance minefields!


" I expect to pass through life but once. If therefore,there be any kindness I can show, or any good thing I can do to any fellow human being, let me do it now, as I shall not pass this way again." Dx 12/2/2004, LCIS/DCIS/IDC, Right, 2cm, Stage IIB, Grade 3, 1/21 nodes, ER+/PR+, HER2+ (FISH)
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Apr 13, 2012 09:01AM cp418 wrote:

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Apr 13, 2012 06:42PM NancyNJ wrote:

Thank you so much!

Dx 12/1/2008, DCIS, 2cm, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Apr 13, 2012 07:07PM NancyNJ wrote:

Thank you!!

Dx 12/1/2008, DCIS, 2cm, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Apr 14, 2012 07:29AM cp418 wrote:

Nancy - when I read your post my blood boiled!!  These insurance companies are EVIL in how they treat patients!  BTW - BCBS NJ is my insurer too ---- the bleeps.

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Apr 14, 2012 03:50PM chrissilini wrote:

That just stinks. Hope things work out for you. I'm waiting for something like that to happen to me. Open enrollment is coming up and you just never know when they are going to jerk you around. When I had my bmx with te's in Dec, the office manager told me a week before surgery that my insurance company didn't approve it yet. They needed more info. What the heck more did they need than the fact I had breast cancer. Really?

I had my exchange to implants in March and although I don't know if I'll need fat grafting, ins won't cover it. They used to but have changed their policy. WTH? My insurance is Cigna.

Good luck to you.

Dx 11/11/2011, IDC, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 12/8/2011 Lymph node removal: Left, Sentinel; Mastectomy: Left, Right Surgery 3/15/2012 Reconstruction (left); Reconstruction (right)
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Apr 21, 2012 05:27PM NancyNJ wrote:

They are evil people - the status so far is basically they're cancelling us and if we don't like it we can spend even dime of money we've put away to pay legal fees to make them do the right thing.....I guess they bank on the fact that with a cancer patient there's an expiration date.

I'm disgusted and frustrated.  Got no help from anyone.

Dx 12/1/2008, DCIS, 2cm, Stage 0, Grade 3, 0/2 nodes, ER+/PR+
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Apr 22, 2012 03:32AM - edited Apr 22, 2012 03:33AM by Lowrider54

Well, I sure am glad I don't live in New Jersey anymore - my suggestion is get together and write letters to the Attorney General - lots of letters - the Attorney General in Minnesota is very proactive and given enough complaints, they are bound to at least investigate the matter. 

All you NJ gals, get out your pens, computer, crayons if you have to - bombard them with letters and maybe you can get some action on your behalf!  Power in numbers...I would look for English Major on here and send her a PM - she is AMAZING when it comes to advocacy and may have some great suggestions for you!

Luck to you all...LowRider will make people wonder what you are up to...Initial dx 04/99 - CMF; 9/2009 bone mets Arimidex; 6/2010 Faslodex/Xgeva; 8/2011; abdominal wall invaded, ER/PR flipped to TN, Abraxane/Avastin//Xgeva 09/02/2011; 11/2011Xeloda/Avastin/Xgeva. Dx 9/16/2009, Stage IV, 5/25 nodes, mets, ER-/PR-, HER2-
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Apr 22, 2012 03:50AM Galsal wrote:

WOW, what an anger building scenario they create with such demands that are ludicrous!  Feeling SO thankful now that UHC and Fla have not questioned one claim.  For that matter, the only two not paid are from when I went for a second opinion and the deductible hadn't yet been met.

Dx 12/14/2011, ILC, 1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 2/10/2012 Mastectomy: Left; Prophylactic mastectomy: Right Hormonal Therapy 10/6/2012 Arimidex (anastrozole) Hormonal Therapy 12/13/2012 Femara (letrozole) Hormonal Therapy 4/16/2013 Aromasin (exemestane)
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Apr 22, 2012 08:44AM - edited Apr 22, 2012 08:47AM by cp418

Is there a way to contact NJ News television and website to publicize this situation? Get the attention of NJ Health officals and Governor Christie?

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Apr 22, 2012 08:55AM Mardibra wrote:

Insurance companies are evil.  Although I have not had any issues with coverage to date, they did call the other day saying "they wanted to reach out and let me know the resources they can provide for support".  Ya, BS....they were asking tons of questions about my BC experience to date and questions about my doctors, etc.  I am just so distrustful of them...gave them the absolute bare minimimum of information.

Good luck to should not have to deal with this.  Disgusting. 

IDC and DCIS. Lumpectomy/AND 10/21/11. Chemo 12/1 - 3/15. UMX 4/13/2012. Rads completed 7/3/12. DIEP reconstruction to begin Jan 2013. Dx 8/31/2011, IDC, 3cm, Stage IIIA, Grade 2, 7/10 nodes, ER+/PR+, HER2-
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Apr 22, 2012 09:11AM lago wrote:

Here are some more links for you:  

DONE!! • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010 Dx 7/13/2010, IDC, 5cm, Stage IIB, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Apr 27, 2012 09:51AM glostagirl wrote:

Hi Nancy,

Just wondering how things are going.  I was researching a simmilar issue for a friend here in MA and came across "Small Group Insurance Laws"  which I was sure you'd also have in NJ.  So I did a quick Google search.

Here's the link:

The bottom line is:

Under 25 hours a week is considered part time and ineligible for coverage

They may be in violation of HIPAA by denying you coverage based on your medical information

They can only cancel you on your anniversary of coverage (renewal) date. 

They may have to provide COBRA coverage (would be more costly) 

...."We must see all scars as beauty. ....Because take it from me, a scar does not form on the dying. A scar means, I survived." Chris Cleave, Little Bee Dx 1/5/2008, IDC, 2cm, Stage IIA, Grade 3, 0/2 nodes, ER-/PR-, HER2- Surgery 2/22/2008 Lumpectomy: Right; Lymph node removal: Right, Sentinel Surgery 3/27/2009 Lymph node removal: Right, Sentinel; Mastectomy: Right; Reconstruction (right): IGAP flap Surgery 6/20/2012 Reconstruction (right): DIEP flap Surgery 11/14/2012 Reconstruction (right)

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