BlueCross BlueShield of Montana
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1 Star Rating
Blue Cross/Blue Shield of Montana now uses third party MES Solutions to handle their appeals cases. If an option of NO stars was available, I would have chosen that.
Our 16yo grandson's surgery at the University of Utah Burn Center has been scheduled for June 13, 2024 since January 2024. It is follow up surgery to address necessary issues related to serious burn injuries he incurred as a 5yo. He has tight, thick scars called contractures across his chest, down both arms, the back of his hands and a large scar band inside his left elbow plus scar webbing between all the fingers on his right hand. This scheduled surgery is to remove the contractures, the scar band and finger webbing then apply graft tissue or BTM to cover the open wounds. It is not minor outpatient surgery-- it is major surgery-- his burn team planned on as much as a 4 week hospital stay to monitor for dangerous infections during daily, sometimes multiple daily bandage changes
plus fit him for custom compression suits and arm splints.
We were just notified by the U of U Burn Center Team on June 4th that BC/BS has denied both the:
- Experienced burn surgeon's plan to use a proven wound cover product called BTM
-Standard in-patient stay after this major surgery
The U of U Burn Team submitted an appeal--- MES denied that appeal.
The U of U Burn Team submitted a request for an expedited decision on another appeal due to the scheduled surgery date --- MES also denied that & stated there was no reason for an expedited decision--- even though the surgery is imminent!
Our grandson's surgery was very intentionally scheduled for June 13 so his surgical wounds have sufficient time to heal so he can safely return to school on time next Fall.
Our daughter-in-law is frantic at this last minute denial of service for her son.
She was left a widow with 4 children after her husband, our son, died suddenly of a brain hemorrhage in 2020.
Despicable- that a single Mother who has experienced enormous burdens since the death of her husband, who works 2 jobs and pays her BC/BS premiums is now being denied the medical care her child needs.
SHAME ON YOU, BC/BS AND MES-- WHAT IF THIS WAS YOUR CHILD?
Our 16yo grandson's surgery at the University of Utah Burn Center has been scheduled for June 13, 2024 since January 2024. It is follow up surgery to address necessary issues related to serious burn injuries he incurred as a 5yo. He has tight, thick scars called contractures across his chest, down both arms, the back of his hands and a large scar band inside his left elbow plus scar webbing between all the fingers on his right hand. This scheduled surgery is to remove the contractures, the scar band and finger webbing then apply graft tissue or BTM to cover the open wounds. It is not minor outpatient surgery-- it is major surgery-- his burn team planned on as much as a 4 week hospital stay to monitor for dangerous infections during daily, sometimes multiple daily bandage changes
plus fit him for custom compression suits and arm splints.
We were just notified by the U of U Burn Center Team on June 4th that BC/BS has denied both the:
- Experienced burn surgeon's plan to use a proven wound cover product called BTM
-Standard in-patient stay after this major surgery
The U of U Burn Team submitted an appeal--- MES denied that appeal.
The U of U Burn Team submitted a request for an expedited decision on another appeal due to the scheduled surgery date --- MES also denied that & stated there was no reason for an expedited decision--- even though the surgery is imminent!
Our grandson's surgery was very intentionally scheduled for June 13 so his surgical wounds have sufficient time to heal so he can safely return to school on time next Fall.
Our daughter-in-law is frantic at this last minute denial of service for her son.
She was left a widow with 4 children after her husband, our son, died suddenly of a brain hemorrhage in 2020.
Despicable- that a single Mother who has experienced enormous burdens since the death of her husband, who works 2 jobs and pays her BC/BS premiums is now being denied the medical care her child needs.
SHAME ON YOU, BC/BS AND MES-- WHAT IF THIS WAS YOUR CHILD?
Product: BlueCross BlueShield of Montana Health Insurance
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