Sunday, September 27, 2009

Shameless Corporation of the Week Award

Each week EverythingHealth will bestow its "Shameless Corporation of the Week Award" to a deserving health insurance company. Somehow I do not think it will be hard to find a recipient each week.

Today's award goes to: Blue Shield of California HMO.

When Rosalinda Miran-Ramirez awoke with bleeding from her left breast nipple she awakened her husband and had him drive her to the local emergency department. The doctors found a tumor that they thought was breast cancer but a biopsy later proved it to be benign.

Blue Shield denied the emergency room visit and she received the total charge from the emergency visit: $2791.00. Blue Shield reviewed the case and determined that Miran-Ramirez "reasonably should have known that an emergency did not exist." When she appealed, she was denied again and told she was not in "any acute distress."

The Shameless Award for this week goes to Blue Shield of California. Since when isn't a blood soaked shirt and a bleeding breast cause for insurance coverage?


Linda Leighton said...

That's appalling!!

Dimi3, CMT said...


KM said...

I had read that Blue Shield had even originally authorized he visit and reversed the charges it when the results showed benign.

jobb said...

I wish I could send a copy of your blog to every client of BlueCross as a warning to find other coverage.

ERP said...

Honestly, it depends on the amount of bleeding. If it was just a little bit, then I would discharge her with follow up to our breast centre for an u/s or mammo. In that case, it probably was not an emergency. An urgency, yes. However, I don't know how that could be determined without speaking to the MD that treated her. Also, if cases like this were frequently denied, then probably 1/2 of all cases I see on a daily basis would be! I mean, I see so many "nonemergencies". I wonder why they picked on this woman out of all the others that came in for colds.

Anonymous said...

jobb: It this was Blue Shield that did this to the woman with the bleeding breast. Blue Cross has it's fair share but so far not as bad as this.