CHARLOTTE, N.C. (WBTV) - A South Carolina woman was shocked to learn her insurance would cover medical procedures in North Carolina but not across the border.
Pat Gerlipp had terrible back pain. She went to the Carolina Neurosurgery & Spine Associates for help. The Center took care of the pain in her back, but then she was hit with painful bills that she thought were covered by her insurance.
“I live on a fixed income, I’m retired, and I have generally, pretty good medical coverage,” said Gerlipp.
74-year-old Gerlipp had two separate injections in April and May of this year at the Carolina Neurosurgery & Spine Associates which has multiple locations
“One was in North Carolina, one was in South Carolina, same doctors, same practice, however, for whatever reason, Blue Cross Blue Shield Federal does not view the practice as being a preferred provider in South Carolina.”
Gerlipp lives in South Carolina, so she went to the practice in Rock Hill. She owed $1529 for one injection and the office visit. However, when she had the exact same injection in Carolina Neurosurgery’s North Carolina office, she says it was covered in full for $1,475.
“I had no idea that if I went to South Carolina I wouldn’t be covered, I was never told.”
Gerlipp contacted the Carolina Neurosurgery and Blue Cross Blue Shield trying to get the problem resolved but couldn’t get any explanation or her bill corrected. So, she called WBTV Investigates.
We contacted BlueCross BlueShield of South Carolina, but they refused to answer our questions.
However, they did say, in part, “someone at a senior level will reach out and walk through the options that are available to her, including filing a reconsideration.”
We also called the Carolina Neurosurgery & Spine Associates who also indicated, “Unfortunately, we are unable to respond to your question or confirm/deny that the person you mention is a patient . . . It is also our general practice not to discuss patient matters publicly.”
However, right after our calls Gerlipp says she suddenly received a call from Carolina Neurosurgery & Spine Associates. She says they reduced her bill to $865.
“The only reason I got to speak to her was because WBTV contacted them after my initial complaint,” said Gerlipp.
“WBTV, you know they have the right places, the right telephone numbers, the right people to contact and then things get resolved.”
Carolina Neurosurgery wouldn’t comment for this story but did send WBTV a statement saying,
“Carolina NeuroSurgery & Spine is not able to comment on any specific patient situation, due to HIPAA and privacy protections. While it is the patient’s responsibility to understand their benefit plan, we do our absolute best to help patients navigate the complexities of their insurance plans. Plans vary widely in their coverage, and it can be a challenge for patients to know what services are covered and at what locations.”