Insurance cut off....?

Question

My step mom had a stroke February of 2007. She came home in August of 2007, even though her speech was still messed up, she is in a wheel chair (can't walk), can't maneuver her left arm, lost of hearing (she has a hearing aide now). As soon as she got home she started rehabilitation (physhical, occupational, and speech therapy). She has made some progress since then, however not enough that she doesn't need therapy. Her insurance (blue cross blue shield) has cut her off as of today. How can they do this? What can we do as far legal matters, can we sue? Please, only useful feedback!

Answer 1

the rehab facility does not know why BCBS stopped paying -- just that they did.

you have to contact BCBS to find out.

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and you're likely going to have troubles because your mother can't speak very clearly on the telephone.  does the company have a physical office nearby?

[in my area, my state's BCBS does.]

Answer 2

Almost every policy has a lifetime maximum that the insurance company will pay. My guess from what you stated  is that she reached the maximum. There is probably very little you can do. You should call the company to get an explanation as to why she was cut off.

You should check your state Medicaid program. Many states have help for "medically needy" where you qualify based more upon your needs and less on your income or assets.

Answer 3

Was her premiums paid up to date?  If she was on COBRA it may have run out. What reason did they give?

Answer 4

It sounds like she has exhausted her benefit.

The insurance probably only covers a certain amount of days.  Some plans cover 20, or 30. Some are 60. Some have no maximum. Its all written in her benefit plan.

Call BCBS. They'll be able to answer this question better than any of us... We're all just speculating. If she maxed out her benefit, there's nothing/no one to sue... They insurance is administering the plan she, or her employer, selected.  Find out when the plan renews, or when she'll have more days available. Maximums are usually set per benefit year. You can also look into community resources.

Answer 5

There are a number of different answers here because we don't know the reason BCBS stopped paying, but these are all possibilities.  

My guess is that because her physical therapy was not substantially improving her situation, she did not need "skilled care" any longer (medical insurance) but needed "custodial care" (long term care).  This is the point when most stroke patients start spending their own money.

If your step mom doesn't have a long term care policy, you should look into Medicaid programs and perhaps speak with an elder law attorney about protecting your dad's interest while getting your step mom care.

Good luck