BlueCross BlueShield of Texasinsurance fraud

L
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I suffered an injury on the job on 10/09/06. I was hospitalized on 10/12/06. The injury and complications were submitted for worker's compensation with gallagher bassett.

I asked my human resources director at the lenexa cadbury schweppes distribution plant how long I had to submit a claim with blue cross of texas if gallagher bassett refused the worker's compensation claim. She told me I had 1 year to file a claim with blue cross of texas. Just to make sure of this, I called blue cross of texas, and they also told me that I had 1 year to file a medical claim.

Gallagher bassett had told me that when they reached a decision on my claim that I would receive written documentation and an explanation of their decision. The months passed by and I never received any correspondence concerning gallagher bassett's decision. As the 1 year deadline drew near, I had all of the health providers submit claims with blue cross of texas. All of these claims were filed before the 1 year deadline.

None of the claims had been paid so I called blue cross of texas to ask why. Blue cross of texas told me that all of the claims would first have to be filed with blue cross of kansas city, and that once blue cross of kansas city received the claims they would forward them to blue cross of texas.

Blue cross of kansas city told me that they had a 6 month period for filing a claim. They said none of the claims would be paid because of this, and blue cross of texas has not paid any of the claims.

The 6 month deadline, and the filing with blue cross of kansas city instead of blue cross of texas was never related to me or my health providers.

Responses

  • Me
    MeandU Feb 12, 2009

    As with all Blues plans your claim should be filed with the plan in the state in which services are rendered. Each state does not have a timely filing limit as that is determined by your group. Although most groups reflect 1 yr for timely filing there are some self funded groups that can choose a different time frame.

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