ProPublica reporter Duaa Eldeib recently published the story of a North Carolina couple, Teressa Sutton-Schulman and her husband, who we identified in the story by his middle initial, L, to protect his privacy. Last year, L suffered escalating mental health issues and needed intensive psychiatric care. Highmark Blue Cross Blue Shield issued the couple multiple denials in their case, even after Sutton-Schulman’s husband attempted suicide twice in the span of 11 days.
Highmark previously said in a statement that the company was “passionate about providing appropriate and timely care” to its members. It acknowledged that “small errors made by physicians and/or members can lead to delays and initial denials” but said that those are corrected on appeals.
The instructions for an external review were buried on page seven of one of the denial letters. Eldeib spoke with experts who are well-versed in writing appeals after care is denied and put together this piece including their advice. You might find it helpful if you’re in such a situation, or if you know someone who is. Please note that we are journalists and not lawyers; we are unable to provide any legal advice about this process.
|
