Cover Physical Therapy Costs and Screw BCBS

My name is Katherine, and I had surgery last fall to have a massive and painful bone spur removed from my right heel. This required removing, repairing, then reattaching the Achilles tendon, along with shaving down the bony growth. The surgery and follow-ups were approved and covered by BlueCross BlueShield with no argument under my previous insurance plan. Unfortunately, BCBS decided they weren't making enough profit with that plan, so they discontinued it, and I was forced to switch to the BCBS Local Wake Forest plan. NONE of my providers were in-network in this plan, but it was the best of bad options.

Concerned about being able to continue treatment with the physical therapist that I'd started seeing in December, as directed by my surgeon, I contacted BCBS's customer service department. I was told by a customer service rep that I would be able to apply for continuity of care in order to continue seeing an out-of-network provider at in-network costs for something I was currently being treated for. That service rep was either misinformed or lying.

After applying for continuity of care, I was told by BCBS that it was not available for customers whose plans had been discontinued. My appeals were denied because an in-network provider was "easily accessible," according to BCBS. Meaning they expected me to stop physical therapy during a critical part of my recovery (I was still in a walking boot and unable to walk without it) and switch to an in-network physical therapist, who would probably have a waiting list or would at least need to be brought up to speed on my procedure and recovery. At my surgeon and PT's suggestion, I continued treatment with them, hoping that my appeals to BCBS would be successful.

Since you're reading this, my appeals obviously were not successful. I even requested an external review from the NC Department of Insurance, but my case was not eligible for review since it wasn't a "medical necessity" determination. Fortunately, my physical therapy went reasonably well, and they were able to release me earlier than they might have liked. Unfortunately, that was only after racking up approximately two thousand dollars in charges that BCBS will not pay a cent of.

I'm out of work, but able to cover my regular expenses with pet/house-sitting gigs and savings. But a $2,000 medical bill is out of reach for me. Any additional funds donated above the goal will help me pay for appointments with the psychiatrist I've been seeing for years, who, you guessed it, isn't in the new restricted network! Any help you can provide would be greatly appreciated.