Monday, 12 July 1999
I receive the following from Blue Cross today:
July 12, 1999
Ms. Carla G. Dionne William C. To, M.D. 1132 Lucero Street 8635 West 3rd Street Suite 265W Camarillo, CA 93010 Los Angeles, CA 90048-6180
Patient: Carla G. Dionne Date of Service: October 5, 1998 Provider: William C. To, M.D.
Dear Ms. Dionne:
We have received the above claim for the services of an assistant surgeon. Based on the information submitted, our Obstetrics Advisor has determined that this service was optional and not medically necessary to safely and effectively accomplish this procedure. Therefore, the service of an assistant surgeon is not eligible for benefit payment under the provisions specified in your contract.
If you or your surgeon has any additional information that may change our decision, please submit this information to my attention at the above address, along with your request for re-evaluation.
Your Blue Cross Agreement contains an arbitration clause. Disagreements between you and Blue Cross, which exceed California small claims court jurisdictional limits, will be settled through arbitration. To initiate arbitration, a written request must be submitted to the above post office box.
If you have any further questions, please feel free to contact us at the following Customer Service telephone number: 1-800-477-2226.
Jonathan Lane, Supervisor
Okay. So now I'm torn. On one hand I don't even know for sure if this doctor (To) was truly even present the day of my hysteroscopy/laparoscopy. I asked to meet everyone that day before the procedure and did in fact talk to the prep nurse, the surgical nurse, the recovery nurse, the anesthetist, and Dr. McLucas. But NOT Dr. To. I never met him. I never saw him. In fact, I haven't even seen anything he's written about his presence on my medical charts either. Just the bills. $1500. They come like clockwork every month from his billing department.
So should I contest the bill -- because I know nothing of his participation in this procedure -- OR, do I appeal the insurance denial?
If I contest the bill, will this end up in court and land on my credit report or even end up with garnishment of wages to pay it off should I lose?
If I choose to appeal, on what basis would I appeal under? I don't even know whether the guy was even present that day!
Either way I lose. No matter what I choose to do, this will require an investment of time to get this resolved. Just one more piece of the nightmare puzzle that I have to deal with courtesy of Dr. Bruce McLucas.
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