Blue Cross Blue Shield is giving us the runaround.
First, they won’t speak to Matthew without a form from me giving my consent for him to discuss my medical/insurance situation with them. Okay, fine. HIPAA privacy laws, whatever. I need Matthew to represent me because I work during the day during their business hours, it hurts to talk and I’m exhausted from radiation side effects, and I simply can’t spend hours on the phone on hold waiting to argue with a BCBS representative. So form duly requested, received, filled out, and sent in last week.
Of course, now they can’t find it.
They also can’t find the reference number for my radiation oncologist’s peer-to-peer discussion with their oncology representative, without which our appeal can’t move forward (it took an hour on hold for us to ferret this information out). Now my doctor needs to have another peer-to-peer meeting with their doctor because BCBS lost paperwork.
Nor, apparently, can they find anyone who will take responsibility for my case. They keep forwarding us from person to person, none of whom knows what’s going on or can effect any movement, take action, or make a decision regarding our appeal.
So frustrated. So furious.
Screw that. File a complaint with the state insurance commissioner. That tends to get them to cough up the goods.
And good luck. UGH.
That’s definitely next up on our list of appeals actions.
So sorry you’re having to go through this crap on top of everything else. Being in the UK I don’t understand much about US healthcare but I see there’s a twitter a/c (I’m presuming these are the people concerned?) https://twitter.com/BCBSGaPR Could you tweet them and get them to look into it?
That’s also on the list of “next steps.” We’re trying to go about this appeals process in the proper and proscribed manner, but it’s looking more and more like we’re the only ones.
Make sure that you are keeping accurate records of everything you send and went it was sent. Cellphone pics will work if u don’t have a scanner. It is easy to photograph the dated letters and stamped envelopes. Next tell them you will be seeking legal counsel and have documentation of everything sent. Finally if it is an employer based plan, have the employee file a formal complaint through their Human Resources department including recommendation for changing benefit administrators due to the inaction if BC/BS. These are all steps which you should take right away. Lawyers or potential lost accounts are the language of money. This is the only language they speak.
This is, I’m sorry to say, typical insurance company incompetence. It truly sucks.
Filing a complaint with the state insurance department can help, but be prepared for possible runarounds there, too. In particular, be sure you know the situs state of the insurance contract; don’t assume it’s Georgia. If it’s not a Georgia contract, the Georgia Department of Insurance has no jurisdiction over it and won’t be able to help you.
Also, verify that your plan is not self-insured–i.e., funded by your employer. It’s possible (unlikely, but possible) that BCBS is only doing the administrative work, and isn’t actually underwriting the coverage. In that case, the DOI might not be of any assistance.
Just a couple of things to watch out for. Hope this nonsense is resolved soon.
Oh, and regarding lawsuits–if your plan is governed by ERISA (and most are), you will likely be required to file two appeals with the insurance company (and have them denied) before being able to take legal action.
This is infuriating and probably them wanting to avoid paying out. It’s ridiculous the games these companies will play with people’s lives. Sorry, it just pisses me off that the dollar and making even bigger profits are more important than people.
I hope this gets sorted out for you quickly. You certainly don’t need the added stress.
Ready to pull the trigger on unleashing social media hell on these clowns whenever you request. Totally incompetent and unacceptable. It’s infuriating that insurance companies get to deny coverage of prescribed treatments for the sick, then it’s the sick person’s and their doctors’ problem to get the dumbass decisions overturned, AND when they’re incompetent it’s your problem too. Totally unacceptable!!!!’
Send certified letters with electronic delivery confirmation to their CEO and their Board Chairman. Detail all the company’s incompetence. Show how it affects their bottom line and their brand reputation.