Julie R. (New Mexico)

May 05, 2023

When you’ve fought for your health care for as long as I have it seems like the fighting never ends. I’ve had to file complaint after complaint and appeal after appeal to advocate for myself, but what I experienced last year with Blue Cross Blue Shield was something else entirely.

In November, I was suffering from convulsions multiple times a day. While this has happened to me before, this time around my convulsions were more extreme – even to the point of choking. No local neurosurgeon was able to treat my condition and everyone I spoke with dismissed it as psychosomatic, despite clear evidence of physiological problems. I knew that I needed to see my neurosurgeon – the only practitioner who understood my condition – in New York by air ambulance. My insurance, Blue Cross Blue Shield of Illinois (BCBSIL), refused to cover the $40,000 bill despite my health providers confirming it was a medical necessity.

I was under so much stress because my first appeal was denied. Then, my second appeal was processed without my consent and ended up being denied as well. BCBSIL argued that what they did was no big deal because I could still file an external appeal. I should not be denied the opportunity to submit a second appeal because they made the mistake of processing my initial second appeal too soon. After an exorbitant amount of pushback from me and my husband, they agreed to review the second appeal again but only gave us three days to submit documentation. We pushed back on that as well, and they relented – now, a deadline they insisted was 100% strict became flexible and we had more time to compile documentation.

I submitted letters from four providers who testified in detail that my air ambulance ride was medically necessary and an emergency. I also wrote a letter myself, rebutting the reasons they’d given for denying it point by point, including a long list of scientific citations to back myself up.

In the meantime, my health was only worsening.

After weeks of back and forth, I won!

I was so relieved that BCBSIL ended up doing the right thing, but it’s unfortunate, to say the least, that I had to fight so hard to make it happen. I was lucky to have the support of my husband and the Twitter community, who helped coordinate a massive online campaign on my behalf to push back on BCBSIL’s runaround and hurdles. Although I ended up “winning,” this experience took a massive toll on my health.

For patients out there experiencing similar challenges, don’t lose hope! Reach out for help and use your voice on social media. Additionally, My Patient Rights offers guidance to help people understand their rights and get the care they need and deserve.