Spare A Rose

Life for a Child

Thursday, December 6, 2012

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. 

11 comments:

Penny said...

OMG. All I can say is I feel for ya honey. This is BS, this insurance mess. I'm not sure how I can help, but if I can do something for you, I will. Haqppy to share supplies. Keep up the good fight. We are fighting too. G's insurance swears they never paid a dime for the CGM she is currently wearing. Bastards.

Kate said...

We also pay a small fortune each month for our health insurance, which will go up again in January. It does make you wonder where they are spending those administrative fees! I'm sorry you are going through this. I firmly believe that the %$#&%*( insurance companies are the reason our healthcare system is such a mess! (it felt really good to type those symbols. I pounded the keyboard)

Mike Hoskins said...

Not exactly the same situation, but close... I've had to take my insurers to the state health commissioner (in Michigan and Indiana) and that finally motivates them - even after my employer switched insurance and I was no longer their current client. Sorry this is happening on your end, K2... give em hell (like you do), and good luck.

Diane Cohen said...

Take a breath- You need to call Robert Marino, CEO if Horizon BCBS,
973-466-4000. Insist on talking to him. They will then out you through to his Executive complaint Group (every CEO has one). These are the people that you want. Make sure to get everyone's full name, title, and phone # at the beginning of the conversation. If they won't give it demand a supervisor.The Executive Complaint Group can really move mountains. Just keep breathing!!!

StephenS said...

Have to agree with Mike here... go to the health (or insurance) commissioner in your state.

I can only tell you (from experience) that BCBS entities usually have multiple people handling multiple issues (ID cards, claims, claims adjudication, etc.) in multiple offices. Sometimes, they all use different systems. So yeah, it can take a while to sort out. Makes you wonder where the premium increases go. Good luck.

Anonymous said...

I had a similar situation years ago over getting lab work paid for. After 6 months of going round in circles w the ins co I sent a detailed complaint letter with details about calls (date, time, person spoken to, details of call, outcomes,etc.) to my States Insurance Board. I couldn't tell you if the letter was the reason, but I have my suspicions that it was why the claim was finally taken care of about 10 days later.

Last time I got the run around, about 6yrs back I just came out and told the rep for the ins company that the appeal (second one) in dispute needed to be resolved in 1 week, not the 6 week estimate they gave me, before I sent a complaint letter in to the State Insurance Board. It was resolved in 3 days. Again I can't say for sure why but will keep this in my playbook for dealing w insurance bureaucracy.

John Anno said...

I am sorry to hear about this, though to be honest I am not overly shocked. I ranted earlier this morning about my insurance company I just left the name of them out; though we have more than diabetes in common lol.

Lora said...

Wow! I'm stressed just reading that.

Kelly said...

Oh my. RIDICULOUS! It is extremely frustrating, isnt it? Indeed contact your state onsurance commisioner!!

I have dealt with the other side for doctors and hospitals as a Medical Billing/claims Specialist for over 15 years. If it makes you feel any better, insurance companies dont pay us easily either! I cant count the times Ive hung up the phone because all I have left to do is lose my cool and start throwing F bombs!!

Scott K. Johnson said...

Whoa - what a mess. I'm sorry. Stick with it, you'll get it straightened out (some good advice here, it seems).

Scott S said...

The insurance business is, IMHO, completely corrupt. Frankly, the Obamacare mandates can't be implemented soon enough (2014 for the most important provisions). I had not-so-good insurance for several years (high deductible, limited network, lousy PBM, inefficient claim/appeal process, etc., etc.) If there is a bright side to this, its that we're much closer to 2014 and insurance exchanges and subsidies thanks to the U.S. Supreme Court are coming whether Christie is Governor of NJ or not.