Does anyone have experience dealing with Blue Cross/Blue Shield?

[Pool Hall Ace]

Back in February, my husband cut his hand while he was out of town. He went to a local emergency clinic and had his hand stitched up. My husband paid out of pocket, and the doctor listed the necessary code on the bill.

I filed the claim for him, and a few days later, Blue Cross returned it with a mailback form stating that I did not include all necessary codes. I telephoned customer service to see what they were talking about. It turns out they don't keep a copy of the claim when they mail it back, but she said what I needed was a five-digit code for the laceration repair, and that I could get it from the doctor's office.

I telephoned the doctor's office in Maryland and requested the code. "Do you need it now?" was the response. "Yes, please." She gave me the code, and I mailed the form back.

I waited two weeks, then checked the claim status online. No record of it. I call customer service. Nope, they didn't have it. I was told to mail it again. I asked if there was a fax number I could send it to instead. Um . . . yeah. The customer service rep starts to give me a toll-free number, stops, then gives me another number.

I fax the claim, wait two weeks. Guess what? They didn't get it. We're getting ready to go out of town, so I send a copy in the mail again. A few days later, it comes back. Please send a legible receipt, and please provide service codes.

I call customer service. I'm fortunate to get someone who sounds human, and is reasonably helpful. I ask her what part of the receipt is not legible, because I can read it just fine. As I'm looking at the receipt, I notice where someone has placed some question marks. Tetanus 0.5 mL, instrument tray, xylocaine are listed. The CSR says that if it's listed on the receipt, then codes are needed.

I call the doctor's office back and request the codes. The office manager (who happens to be the doctor's wife) says she will look them up for me and call me back.

A few hours later, she calls and gives me the codes for tetanus and xylocaine. What about the instrument tray? She says, "Sorry, I don't know." Silence. I take a slow, deep breath -- inhale, exhale. "Well, someone from your office wrote it on the receipt. Could you ask that person, please?" She says okay, she will call me back.

A half hour later, she calls back and gives me all the codes again, including the one for suture tray. I neatly print each service on the receipt, along with the CPT code.

At this point, I'm long past tired of monkeying around with Blue Cross, so I take the claim to the post office to have it sent certified mail. A few days later, I check online, and see that someone has signed for the envelope. This was in mid-October.

There is still no record online of the claim. My patience is shot with Blue Cross. I'm not sure what to say to them at this point. I'm tired of this claim constantly getting misplaced. Claims sent from doctor's offices seem to be processed just fine. Can anyone share any advice on dealing with insurance companies? Thank you!

[mzteris]

1. ask for Supervisor -

don't take "no" for an answer. Tell the CSR that they DON"T WANT TO TALK TO YOU 'cause you are way to po'd at this point - usually they will pass you along gladly.


Ask for every person's name and job title that you talk to. Write down the date and time you talk to them.

Make sure they KNOW you are taking names. If that supervisor doesn't give you satisfaction - say handling immediately - or calling you back within 24 hours to tell you the course of action taken, then call back and ask for HER/HIS Supervisor!....

Ask them to "read back" the computer CSR trail of all of your previous calls, etc......... - so they have to acknowledge the complete FU.

Writing up everything you've said - with as close to date/times as you can with as much detail as you can - will help you in the phone call. Offering to fax/mail said report may help get results, too.

[Pool Hall Ace]

6. I spoke with a friend of mine (a non-practicing physician) and he

suggested pretty much what you did. He said he's 99% sure that they cannot cancel me strictly on the basis that I call customer service too frequently. After I recounted what I have done so far in my OP, I realize that I've been waaaay too patient with these numbnuts so far.

I think I'll wait until after Thanksgiving weekend. I'm guessing the office has probably cleared out this week, and if I leave a message, it will just conveniently fall into the black hole that has apparently swallowed up my claim.

[mwooldri]

2. Which BCBS are you talking about, and what kind of plan?

I work for a major CC company, and our BCBS is actually out of New York and not NC where I live and work. Whenever I have had problems in getting BCBS to pay up for things we were entitled to, I contacted HR and they handled it for me. I had a crazy situation when Empire (our BCBS system) would only pay part of my son's room bill - they said he had to be in a semi-private room but the hospital (Baptist in Winston-Salem) doesn't have semi-private rooms for infants and children, only private ones. Our previous carrier, Cigna, had paid up with no problem at all. We switched from Cigna to Empire BCBS because a couple of doctors we wanted to see don't take Cigna and as such we had to switch to Empire.

Because my son has a chronic health condition, he is often in and out of the hospital. My wife also needed some major surgery to control an ongoing problem. As such we have a case manager assigned to our family that we can call upon if we have questions.

Certainly asking for supervisors would be a good plan of action, you could ask for who your case manager is also. That way if you have any other problems you have a point of contact within that BCBS who can help out.

Mark.

[Pool Hall Ace]

3. BCBSNC, Blue Advantage Plan. My husband is self-employed,

so there's no contacting HR. :-(

I will certainly try asking for supervisors, but I think my biggest concern is that they will come up with an excuse to drop us. My husband actually told me to just forget about the claim, but I'm not ready to do that.

He even suggested going without health insurance and just paying out of pocket. I can see his point, because we're paying just under $500/month and getting virtually nothing in return, but I think it's a bad idea to be without health insurance.

[mwooldri]

4. Oh boy :( - sorry to hear that.

Well, there is another thing: going out of pocket for things like regular doctor's visits but get a bare bones insurance package that will cover for drastic injuries or illnesses, i.e. an insurance package with an extremely high deductible. This would cover your family if there was an extended hospitalization, or if you add to your family but your newborn was born with a critical condition like my son. However, I think a talk with an insurance professional would help greatly. I am not one, but if you're paying $500 a month for Blue Advantage, which works AFAIK like a group plan in terms of extra costs you have to pay to see a doctor etc, then if a very high deductible health insurance policy is say $200 a month - then that's $300 that can pay for a general doctor's visit many times over. Of course that extra money could be put into a health savings account (tax free dollars).

However you're right - we all need insurance of some kind or another. My son was born with bladder exstrophy. His hospital and surgeon bills for the first four months of his life was easily over $300,000. He's had another $200,000 since then, and he's not yet three. I'm employed with a group plan and all I had to pay was the three hospital stays of $500 a time the first year, $1000 the next (as the plan changed to pay 90% of costs instead of $75 a night at hospital), and so far $300 this year.

Sorry I can't help but yep, go speak with a Sup. See what that does. And good luck!

Mark.

[patriotvoice]

5. 'HR" for small business and those self-employed

You may consider contacting your bank to see what insurance services they offer. BB&T, for example, has a Group Insurance Services division, which will take your employees' profiles, research the best plan for your circumstances, arrange the contracts and coordinate the deal, and then remain on as group coordinator. If you should have trouble, you can then contact the group coordinator (who is your agent) and work together to resolve the differences with your insurance carrier.

This approach is ideal for those without a dedicated, intra-company HR department, because it offloads the task to someone with expertise and clout, and is, at least in BB&T's case, provided as a value-add service to banking customers; so no additional cost.

Our company uses BB&T GIS and have our two officers insured under it with full medical, dental, vision, chiropractic, psychologic, and life & AD&D coverage. The best plan for us turned out to be BCBSNC, and the questions and troubles we've had have been resolved with the help of our agent. Highly recommended. If you're interested, contact me personally, and I can refer you to our group coordinator.

Regarding "not having health insurance," I can say it is strategically better to have it, despite it being tactically aggravating. Insurance is primarily for catastrophic events, rather than mundane situations. It's more of a perk to have insurance cover routine visits, which is why it's important to look for carriers who reward you (with, eg, lower rates) for staying fit.

[bdot]

7. We have it at this crappy contract job.

It's worthless. They don't like to pay for things like injuries.

[surfermaw]

8. Medical Claimes

One of my neighbors that works from home filling out claimes to Blue Cross and other companies, said"Blue Cross sends back more claimes to be corrected than any other company", however I have Blue Cross as a supplement and have never one time in 10 years had any problem with them.

[benEzra]

9. No experience with BCBS of NC...

but we had BCBS of Florida when we lived there, and they were great. Our 6 y.o. son is a cardiac kid and BCBSF paid probably $750,000 in medical bills, all over the country (including Children's Hospital Boston) with no complaining, including a $21,000 ambulance bill from his first week of life (critical care jet transport from Florida to Birmingham and then Boston), an open-heart at 10 days old, 7 angioplasties at UAB and Boston, and a $330,000 heart surgery and sequelae at Boston when he was almost 4 (we almost lost him that time, and he was in the hospital 6 1/2 weeks).

Each state BCBS is an independent company, but they have to meet the national BCBS network's standards in order to belong.

If you don't get things resolved by being the intermediary, you could also give the BCBS person the doctor's office phone number (or vice versa) and try to get them to talk directly instead of sending everything through you.