This story has been updated to include a response from Blue Cross and Blue Shield of Alabama.
Benny Evans has been bedridden at his home in Goodsprings for 12 years. After dealing with medical coverage issues, he hopes his story will serve as a cautionary tale to others.
After osteomyelitis, a bone infection, cost him half of both femurs and part of his sacrum, he was unable to get into a wheelchair. Evans has been under constant care, having open wounds for 11 years and undergoing multiple surgeries. On top of all that, he is undergoing chemotherapy and radiation to fight cancer.
Evans became a paraplegic at 14 years old, but he's never given up. As a teen, he never considered his challenges. He became a scuba diver at 17 and has experience in breaking horses, making custom saddles and drag racing. He went on to open two small engine shops and become a postmaster before working with the Social Security Administration.
Osteomyelitis forced Evans into retirement, so he has Medicare and Blue Cross Blue Shield (BCBS) through the Federal Employee Program (FEP).
The insurance covered the ambulance transport to the doctor's office for his annual visits for years. It costs $3,800 for Evans to be transported to the cancer center in Huntsville, and around $725 one way for his other visits.
However, in February 2022, both Medicare and BCBS stopped covering medically necessary transports, unbeknownst to Evans, leaving him on the hook for nearly $30,000.
"If anything changed or if there was a policy change, I don't know," said Evans. "I just know I had almost died, and I was in need of more life-saving medical attention. It wasn't until months later that I started getting bills from EMS that I found out insurance had stopped paying."
Evans has appealed the denials and is awaiting a response. A patient advocate is also working on the case. In the meantime, he said he's already heard from collection agencies.
"The collection agents have been really nice because I've explained everything to them," Evans said. "They're doing their job."
The confusion deepened for Evans when he began to receive transport coverage sporadically. He called BCBS numerous times and has been unable to get answers.
"Everybody that's looked at this has gone, 'We don't know what's going on," Evans said. "I spoke with a plan specialist at Medicare that said, 'I don't understand why they're not paying this.' I said, 'I don't know either.' My doctors don't understand it. Everybody I've talked to doesn't understand why they're not being paid by my insurance."
At 58 years old, Evans wants to use his voice to caution people about the risks of insurance denials. He hopes his story resonates with others who will take his warning seriously.
"It's soul-crushing," Evans said. "I mean, it's infuriating. It's soul-crushing. It makes you want to just absolutely give up. It'd be cheaper to die. Of course, I'm not the type, believe me, I'm not the type that gives up."
1819 News reached out to Medicare and Blue Cross Blue Shield FEP for information on patient transport coverage.
Evans has Blue Cross Blue Shield FEP through Blue Cross Blue Shield of Alabama.
"Blue Cross and Blue Shield of Alabama covers ambulance transportation from home to hospital and emergency facilities," said Sophie Martin, BCBS of Alabama director of corporate communications and community relations. "Coverage from home to a physician’s office depends on the member’s specific plan coverage and health condition at that time. Due to HIPAA requirements, we cannot discuss coverage specific to any member."
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