((((Marle))))
I would strongly encourage Megan to file a complaint with the Michigan Dept of Insurance. I would advise her not to say that the service was not needed in hosptial- That is what BC/BS is saying - that it wasn't medically necessary so they want the money back. it is called recoupment and it just plain stinks. Carriers (not mentioning any names, but 3 guesses who i think is the worst) do this all the time and show their word is good for nothing. They pre-auth then medical review later and take their money back. I would strongly suggest that the argument is that she needed rehab for her opiate addiction - she could not be unsupervised and she needed the counseling program as well as the medical detox to make it. It does not hurt to cc every local legislator you can think of and to emphasize the pre-auth and the fact that here she was trying to get better and because she did, they are now trying to recover the money.
Here is the contact info for the Michigan Office of Financial and Insurance Regulation. They also have a website and a complaint form she can download and fax or email in.
OFIR Consumer Services
PO Box 30220
Lansing MI 48909-7720
Or fax to: (517) 241-3991
Or Email to:
[email protected]
Wishing you all the best in this battle. Let us know when you win!