Don's complaint:
September 04, 2014

Insurance Company: Blue Cross and Blue Shield Association
Coverage Type: Health Insurance

• Claim Handling - Denial of Claim

I am writing to our government about health insurance making decisions of basic healthcare and I would like an explanation. Back ground had surgery on my right knee meniscus tear fixed about 10 years ago awesome job was done. Playing a sport last two years platform tennis looking to get ranked in the top 250 after two years. I am playing 3 weeks ago and during a point I feel like my knee is unstable and my give way something wrong. Try and play on but just not right so I stop. When walking over the next few days every now and again turning or coming down stairs something is not right about my knee. Not sure what be just feels like something serious is going to happen with the wrong move. I am almost 52 in good shape and always playing sports. I decide to go see the same doctor about my knee. X-ray is performed, exam is performed twist, bend, touches the knee can not find anything wrong. X-ray comes back doctor says your knee is in great shape. So what is the next step. Doctor says well the next step would be an MRI to look at the soft tissue however lets see what happens by you go back home and if you still feel there is an issues or feel it is getting worse let me know. You can just call me and we will get it scheduled. So I go home then travel to Germany, When I was at the airport in the UsAirways lounge I found myself where I could not put any weight on my leg. A few minutes later I am okay. Get over to Germany play golf the next day. During the golf I Find that the sides of my knee and the area in front / below my knee cap does not feel right. While walking I find myself limping then okay. Every now and again I turn and it feels not stable. Something is definitely wrong. So I call from Germany and ask them to schedule the MRI. A week later I get back on Sunday before Labor Day. Call the hospital to see what time I can get this done. They say they have no pre-cert for me. Call doctors office they tell me the insurance company has denied services. First off I pay them 1800.00 a month so that I get good care and I am denied good care. The reason for my concern is I start platform tennis season on Thursday and really want to know before I really get hurt. I am very worried about my knee. I now call the doctor and say this is wrong. So he calls on my behalf and explains but they still say no. There answer was rehabilitation. My question to you and our government is why is the insurance company the doctor deciding what treatment should be! Rehab of what? The doctor has no idea of the proper treatment for rehabilitation. How can rehab something if you do not know what you are rehabbing . This is totally wrong. I am being denied proper care however they will take my 1800 dollar every month. Ny the way my new policy started September 1 and it\\\'s now 2000 plus per month.
Somebody please give me a good explanation as to why I am being denied the next step in proper treatment. I want it noted that I start paddle tennis tonight and I hope I do not not get hurt.
Please call me today 9/4/2014 let me know what I should do about this bad system of healthcare with blue cross blue shield. Thank you

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