Horizon Blue Cross/Blue Shield BLUES

I pay a hell of a lot out of pocket for health insurance. Seriously, what I pay a month would be the equivalent to someone with a smallish mortgage or leasing a luxury car for 27 months - Yeah, I’ve played with the numbers enough to know that. 

So when Horizon BC & BS sent me a new insurance ID card with 3 new/additional letters, in essence giving me a new membership ID number. Nnot only did I let all my doctors know - I also showed them the card and pre printed out at least 10 copies of said card to give to them when I went to their various offices-in person. 

I also called their offices directly, like & I did with medtronic (pump supplies) & EdgePark, my durable medical equipment (test strip) suppliers. 

In early September, the onslaught of denial claim letters started to arrive.

These letters from Horizon BCBS stated: 

“WE HAVE NO RECORD OF THE IDENTIFICATION NUMBER SUBMITTED TO THE SUBSCRIBER.”

You know the, the IDENTIFICATION NUMBER, right??  You know, THE ONE THEY ISSUED ME!!!  YEAH, THAT ONE! 

And since September these letters have arrived weekly. 

Now I’ve called and spoke with the same supervisor (Mr. Supervisor) numerous times, and together we found a few things. 

1. They printed the wrong PO Box on the thousands of cards that issued in August. 

    We found that out by comparing what he told me my card should say, and me telling  him what my card actually said. Yeah, they might have wanted to use an Editor on that project

1. He did more digging and found out there was a glitch in the system when it came to my ID Number - which is why my claims weren’t getting paid. Good to know!
2. He actually put a rush on the claims filed up until the beginning of October - which was when we figured out the problem
3. I called again at the beginning of November after my hand doctor’s office said they would send the balance of the unpaid claim to a collections office  - in essence, affecting my good credit. Mr. Supervisor called them (and my other doctors offices) and Dr Hand’s office isn’t sending me to the preverbal credit cleaners...... YET. 
4. And Mr. Supervisor also put a rush on the October/ November claims since our last conversations  - And he told me to be patient. 

Here’s the thing: Horizon’s rates go up by about 20% or 1/5  ever year due “administrative costs, “ so you’d think that a systems IT glitch would be fixed, ASAP. But that’s not the case. 

It’s still happening and now there are thousands of dollars worth of unpaid claims and Horizon is still working on the glitch. 

I’ve spent countless hours in person and over the phone with people from various doctors offices and Mr. Insurance Supervisor to no avail - And I've taken countless hours off of work to deal with these issues. 

I’ve also spent  numerous hours on the phone trying to get in touch with Mr. Supervisor because for some reason, Horizon does not believe in giving their supervisors/ Reps direct extensions. 
I’ve had some reps argue with me that there was no problem on their end and that everyone else (my doctors and DMEs) are filing their claims wrong. 

45 minutes later the reps  would sing a different tune when they dug deep into the reference numbers and realized that maybe it was a problem on their end!  Those calls lasted on average 1 hour to 1 hour and 15 minutes before they even try to reach Mr. Supervisor.

In the past week I’ve received two letters re: two of the many claims with issues, 

that were sent to my  old and now nonexistent address, which the post office forwarded  - And I have no idea why they sent them there,, considering my bills get sent to my current address. 

These letters: PROVIDE YOU (me) WITH WRITTEN NOTICE THAT WE ARE IN THE PROCESS OF VERIFYING INFORMATION SUBMITTED WITH THE CLAIM.

FYI: They don't do rush on claims with issues, so It could take up to 6 months for the healthcare providers to receive their payments.

Now let’s be clear here - I’m still paying my monthly premiums (actually a little more than my monthly premium because I almost always pay into the following month’s premium by at least $50) and they are still cashing my checks. 

So what the hell gives? 

My premium rates go up every year by 20% due to administrative fees, I’m paying those fees so fix the glitch and pay my doctors and DME suppliers. 

I’m beyond stressed and just all of my lunch hour with Horizon Customer Service Rep trying to get a hold of Mr. Supervisor - who was with another client and couldn’t speak with me - But PROMISED to call me when he had the chance. 

This is now affecting my health on many levels, I need a follow up with my Hand doctor because the carpal tunnel/ trigger finger is still giving me issues - But he’s still waiting to get paid. And I see my Endo in mid January - And he’s still waiting to get paid. Not to mention the fact that my DME and pump supplies still haven’t received their payments for this quarter!

And it’s stressing me the hell out!  I’m tired, I’m angry and the last thing I want to do is for this to continue well into the new year.

So after spending all of today’s lunch hour talking to a very nice rep who tried to reach Mr. Supervisor ( according to his IM, he was helping someone else,  again. But according to his very nice co-worker, he promised to call me back) sometime today/tomorrow. And  I burst into tears after I hung up the phone.  

I don’t want to have take legal action  - I just want my claims paid and for no one else to have to deal with a systems glitch regarding their healthcare care provider. 

Anyone else deal with a similar issue with their insurance company? How did you resolve it?   And any and all advice is greatly appreciated.