Insurance giant owes hundreds

Seven On Your Side
May 13, 2009 2:53:53 PM PDT
It was a little super sleuthing that uncovered a big problem for one Long Island consumer, who was convinced her health insurance company had short changed her coverage. "I deal with life and death everyday." Roz Rockowitz has multiple medical problems. She's battling with everything from herniated discs, to an airway obstruction, to a MRSA infection. As a result, she takes numerous medications and her medical bills are astronomical.

"I have multiple problems... Each of which can be fatal," says Roz.

Roz pays extra for a PPO or Preferred Provider Organization coverage so she can see doctors out of the insurance network. But for last few years, Roz has been told that her charges were not covered because Empire Blue Cross was not notified.

"They claim that I didn't get prior authorization and with a PPO you don't need authorization," claims Roz.

And when Roz calls, "They don't fix it." So the bills started piling up.

"We have depleted almost all of our savings," says Roz. "We've tapped into our retirement funds. To finance medical treatment."

So 7 On Your Side called the insurance company. Just days later, Empire responded apologizing for a billing mistake. It turns out she was being processed as an HMO member.

And soon after, checks from Empire started rolling in.

"I received a total of 45 checks from Empire Blue Cross/Blue Shield," said an amazed Roz.

Empire corrected each claim, some by just a few cents, some by more than a hundred dollars. In all, Roz got $1054.75 refunded. She's told more refunds are on it's way. It's a costly reminder to always question your insurance coverage. Roz was just relieved and happy, "You are amazing. What 7 On Your Side did for me is just amazing." ----

Story by: Tappy Phillips


Produced by: Steve Livingstone

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STORY BY: Eyewitness News reporter Tappy Phillips


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