Complain about a product or service

Blue Cross of South Carolina

Roslyn of Darlington SC (07/10/05)
For past 7 years, I maintained Blue Cross Blue Shield coverage through my employer; effective May 1, 2005 this coverage ended due to layoff. I applied for individual coverage in April 2005 (before coverage ended). BCBC requested my medical records from my Heath Care provider. I received a letter from BCBS stating that they could not offer me coverage based on following health history: elevated Sed Rate (56)in 2001 with no diagnosis/current information. Pee Dee Health Care, Darlington, SC had not updated their records and had sent BCBS obsolete data.

I've had blood work done several times since 2001 - most recent blood work was February 14, 2005. Pee Dee Health Care submitted claims for all blood work including Feb. 2005 to BCBS. BCBS sent me EOB and has paid on the February 2005 claim. I contacted Pee Dee Health Care; they said their files hadn't been updated and they would fax my current blood work (which showed my Sed Rate was in the 30's) to BCBS - the letter also stated that Pee Dee Health Care was unaware of me having any medical problems (and that Sed Rate is not an indicator of any specific disease) to BCBS. Pee Dee Health Care faxed the corrected infomation to BCBS.

Additionally, I sent them data which included, copy of letter from my Doctor, EOB (February 2005) BCBS sent me which included payment for Sed Rate test and recent bill received from Pee Dee Health Care which included the Sed Rate test.

Since sending this information (June 22, 2005) to BCBS, I received a letter stating that my Appeal was denied (no reason noted). I've phoned BCBS 3 times since then - initially, I was informed denial was based on the 56 Sed Rate (old data); later I was informed no reason was stated for the denial. I explained to each individual that the 56 Sed Rate was obsolete (2001) and that results of current Sed Rate had been submitted. The first individual told me to call back in a few days and the others said they would check and call me back. To date no one has called back.

Consequently, I've phone (Pee Dee Health Care (Medical Records) several times. I left messages informing them that BCBS was still denying me coverage based on the 2001 records they sent; I asked that they contact BCBS to correct the error. Pee Dee Health Care has not responded. I've never been diagnosed with any health problems; my doctor has never discussed Sed Rate blood work with me; the rejection letter from BCBS was the first mention of Sed Rate. If I had/have a medical condition (Sed Rate), my doctor has never bought it to my attention, prescribe medication or followup.

I currently DO NOT have medical coverage. Because Pee Dee Health Care sent BCBS obsolete medical data, I've been denied coverage. Although, Pee Health sent updated blood work, BCBS is still denying me coverage.

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