Blue Cross Concedes Health Insurance Coverage for Hospitalized Client
This client retained our services to appeal a denial of insurance coverage for a psychiatric hospitalization. Blue Cross Blue Shield (BCBS) claimed that the hospitalization, which was for over two months, was not considered medically necessary. We obtained the entire medical record from the hospitalization, which included extensive documentation that the hospitalization was indeed medically necessary, and convinced BCBS in an ERISA administrative appeal to pay the claim. We also helped the client work out a settlement payment plan on the remaining balance owed. Additionally, we successfully had removed from client’s credit report an additional disputed hospital bill.