Hey guys. My partner and I have an insurance issue we would like advice on. So my girlfriend enrolled in a Blue Home with UNC Health Alliance plan through Blue Cross and Blue Shield of North Carolina via the Marketplace beginning in December 2024 while working in North Carolina. Prior to accepting a temporary work contract in Virginia, she contacted BCBS by phone in September 2025 to confirm coverage outside her home state. During that call, the BCBS representative explicitly confirmed she would be covered for up to 90 days in Virginia if she completed a Temporary Residency Form, which was emailed to her the same day, completed, and mailed promptly as instructed. She called again to confirm that Planned Parenthood Charlottesville would be covered and was told yes. Relying on these representations, she obtained medically necessary care in Planned Parenthood in Charlottesville, totalling $1,972 with copays paid.
She also had an urgent orthopedic evaluation and surgery at University of Virginia Medical Center in October 2025 because she stepped on a sea urchin, which got infected and was not weight-bearing for a week. BCBS at the time paid $12,406.33 toward the UVA hospital claim, then reneged and said nothing was acutally covered from all of these medical visits. This resulted in approximately $20,000 in medical bills to my girlfriend, and she is at her wits' end trying to see what she can do. I have no idea how to help her. We don't have written confirmation of coverage when she moved to Virginia, but she filled out and mailed the required documentation as soon as she got it. She sent an appeals letter to BCBS, but they said they would have a reply for her appeal in 30 days. What should we do to tackle this? Do we talk to either of the state’s Department of Insurance, or escalate this on the Marketplace? What else can we do, especially pertaining to Planned Parenthood and the surgery done in University of Virginia Medical Center?
Please help me. I just want to see her smile again.
Insurance Won't Pay for Sea Urchin Surgery
byu/dtaricat inInsurance
Posted by dtaricat
1 Comment
Man that’s brutal, sorry you’re dealing with this. The fact they initially paid the $12k then clawed it back is sketchy as hell.
File complaints with both NC and VA’s Department of Insurance and escalate through the Marketplace. Document everything from those phone calls if you can. The Temporary Residency Form is your strongest angle since you followed their instructions.