Annabel,

I often wonder how BC/BS is a "non-profit" company when everything they do seems to be motivated by trying to get out of paying claims. I guess any profits they have are distributed to the higher ups and there is no profit left to report. I'm not too cynical, am I?

I have taken on BC/BS twice, once as a dentist on behalf of a patient and once on behalf of my wife's claim for payment for an osteoporosis drug. I won both times, but it wasn't easy. In the first case when I threatened to sue them and filed a claim in small claims court, I got a call from their president and he said "why didn't you call me, I'm sure we can find a way to settle this". I told him that I was stonewalled by his employees and they would never let me get past the supervisor level. That's how they work. In the second instance, phone calls and letters got me the payment.

Most of the time, they win because their policies are written in such a way that they can opt out of paying. Minnie's case is one that bears this out. Unfortunately, logic never is a factor in their decisions. It's usually what's written in black and white.

So, the first thing that you have to do is read the contract for exclusions. Remember, not all policies are exactly alike, so you mom's may not have the wording that Minnie's does. I would think that if you find similar wording, it's probably not worth your fighting. However, you never know and if you have the time, give it a whirl.

Good luck and please let us know how you make out.

Jerry