I am back home watching footage from this years debconf, which of course is already working to feed the nostalgia. I have more to say about the conference but just wanted to thank everyone for a great debconf and here are some of my photos.

1. Being at debconf.

2. Having your blog entry slamming Blue Cross Blue Shield of NJ be on the first page of a google search using both the terms Blue Cross Blue Shield New Jersey as well as Blue Cross Blue Shield Horizon.

Get these boys some sun…

So one of the (many) sucky things about having a parent with alzheimers is that someone usually has to take complete responsibility over their financial affairs. That person happens to me and the transition, I have to say, has not been all that smooth nor easy.

Manging less than 20,000 per year while a graduate student was somewhat manageable. Taking care of my mom’s finances, bills, expenses, bank accounts, insurance etc. on top of mine, and largely doing this long distance, has been a whole other (difficult) ball game.

To try to make things easier, I chose to use Citibank as I also have a joint account with my mother with them in PR. Well, life has not been made easier by this but, in fact, has been made harder.

In a nutshell, the problem is I can’t LINK nor even transfer money, between my US based Citibank and my PR based Citibank, which is somewhat ironic (and imho, really messed up) because one can transfer money from a non-Citibank bank into a Citibank account (which means, soon I will no longer have a Citibank account).

Why? Aside from the fact that PR always seems to get short changed, I had a conversation on the a very nice customer service person who let me know that there is just a lot of fraud between Puerto Rico and the United States. And one way they keep it in check is by disallowing links (and even one time transfers) between Citibanks in PR and US.

Now, I can’t speak completely to the cause of the high prevalence of fraud but I am sure that their “security” practices don’t help, for in fact, like many banks, their security is especially insecure, particularly vulnerable in Puerto Rico and all of Latin America. And the security hole has to do with a cultural practice.

In a nut shell, the main security question you are asked on the phone when you call in is your mother’s maiden name. Now in the United States (and I think Canada), your maiden name is may not be all that common of knowledge. But in Puerto Rico, it is *super-duper* common knowledge. Not only do people just know this, but it is printed everywhere, like your license.

So Citibank:, perhaps one reason driving the high level of fraud is bad bad bad bad security.

I have tried to let customer service know of this problem but outsourced Indian labor just does not get my explanation (I don’t think there are scripted computer answers for my concerns) and those who get it, don’t seem to do anything about it.

What will it take to change this?

Sorry if someone has already mentioned this, but I don’t think it hurts to repeat it.

If you are heading to Debconf and are traveling through Heathrow, and I reckon any UK airport, keep all your stuff to 1 bag total. Or make sure one piece can fit in the second so you can more easily pass through security.

I promise to write about something else very soon, but I have to post this given what I have just written. Ms Oprah is seeking Healthcare Insurance Company Experiences

Tell us about an experience you had with your healthcare insurance company. Please write in only if you are willing to appear on national television.

I am sure my story is babycakes compared to the scary stuff that is actually happening out in the so-called “Land of the Free.” Like people being denied some cancer treatment, them dying, and then some of the head honchos feasting on their major organs, but hey, I submitted anyway.

Are you having trouble with your health insurance? Are they stalling on paying a bill? Denying a claim? Not telling you what the heck is going on?? Well you can and should take action to eliminate some of the mystery and move forward, and possibly win fight against the health insurance company.

Thanks to my unpleasant ordeals with BCBS of NJ, I have compiled some handy resources and tips to get you started. Good luck and I welcome any other tips that you think should be here. Please email them to me at biella(at)gmail(dot)com

Can’t get a straight answer when dealing with health insurance representatives on the phone? Are different representatives providing different and contradictory information? Does talking to the representatives leave you with a pounding headache? Then the following may be helpful:

1. Ideally you should tape record all conversations. If this is not possible, get the name or employee number of the person you are talking to and write down what they told you along with the time and date. If they have agreed to something, make sure they send it to you in writing. This sort of documentation may come in handy later when you are trying to contest or prove something.

Is your insurance company flip flopping on a claim? For example telling you that the claim is still being “reviewed” but sending you statements that indicate it has not been paid and never will be? What action can you take to inch things forward? The following may help:

1. Most states have a Department of Banking and Insurance and they are there to help you. Many (perhaps all) provide a service for filing a complaint against your health insurance company and other insurance and banking companies too.

When I used the service in NJ , I got assigned an investigator and their service was prompt and helpful. It was my experience that even though they were not able to resolve my issue, the insurance company started to make firm decision on many claims and this alone has been helpful. Before this, it was impossible to get a clear answer from them as to the state of all sorts of claims.

They said “NO,” & you think they should say “YES, YES, YES, YES!!!!” In other words, appealing a denial:

1. This site has some great information on how to avoid a denial and what you can do to fight one.

2. Included on their site is the Health Insurance Laws and Benefits Tool which will provide specific information about your rights in different states. For example, you will want to know if there is an external or independent grievance system to appeal your plan’s decisions. In the case of NJ, which is the state I am fighting, the tool provided the following helpful information:

Does New Jersey require an external or independent grievance system to appeal your health plan’s unfavorable decisions?

Yes, for all health plans.

On what grounds can you file your external grievance?
Investigational treatment appeal, medical necessity.

What is the status of the external grievance panel’s decision?
Binding.

External grievance systems allow you to take a dispute with your health plan to a doctor or review board unaffiliated with your health plan. Thus, both you and your health plan receive an impartial ruling on its decision to deny coverage of services or treatment. Additionally, you can file a complaint against your health insurer with your state’s department of insurance.

Additional Helpful Information and Resources

1. The message boards on lawyers.com are a great place to hit for information. I have found folks there helpful.
2. You many want to blog about your experience as you may get an unexpected response directly from your insurance company. I think there are pro’s and cons to blogging about your experience but it does provide a public face to your ordeal and allows you to chronicle exactly what has transpired.
3. If your cases is particularly shocking, do not hesitate to hit the local media.
4. If your claim has been denied by an external review panel, you may not have much luck suing but if there is no external review panel, you can and should also try Small Claims Court or other legal action. Further, even if your claim was denied by an external review board, you may have other options for suing, for example, due to their bad faith handling of a claim. And on that note, here is a great legal resource covering the topic.

A few weeks ago, I posted an account of my trials and tribulations with Blue Cross Blue Shield Horizon of New Jersey. Well now it is high time for an update, an update I think readers of this blog will be interested in because it tells a fascinating story about the Internet, blogging, and perhaps new uses of Google Alerts.

My goal in writing the post was to inform readers of their options when faced with problems caused by their health insurance company. Well, I had no idea a response would arrive from Blue Cross Blue Shield, and so quickly. For within 2 hours of posting my blog entry, the Public Relations Director of Blue Cross Blue Shield of NJ wrote me an email, which basically said that he “came across my blog posting” and was offering his assistance.

Needles to say, I was shocked. After months of getting some of the worst customer service I have ever received (when on the phone with Blue Cross, I always felt like I was talking to smarmy collection agency reps), I get an email from upper-level management, offering his assistance.

At first, I thought some of my geek readers were playing a practical joke on me. While it seemed plausible that Blue Cross monitors links to their site, and probably do so with Google Alerts, I had a harder time believing that the Director of Public Relations would fire off an email to me, directly.

Naturally, following the arrival of his message in my inbox, a small glimmer of hope flickered, especially after he had someone from the Appeals Department contact me. And this small intervention had a large noticeable effect: decent and transparent customer service became a reality, for the very first time. Instead of interactions that were opaque and frustrating, I finally had ones that were crystal clear and intelligible.

According to the main Blue Cross Blue Shield Web Site, they pride themselves on “Blue Distinction:”

“Blue DistinctionSM is the Blue Cross and Blue Shield companies’ nationwide program that will create an unprecedented level of transparency with two goals: engaging consumers to enable more informed healthcare decisions and collaborating with providers to improve quality outcomes and affordability.”

The contrast of my service before and after having the Public Relations director contact me speaks volumes to the actual nature of “Blue Distinction” as it pertains to BCBS of NJ. For most of my interactions with Blue Cross Blue Shield, I encountered an unprecedented level of opaqueness and frustration until there was intervention from high-above.

I actually appreciated the service I received and saw it as a laudable move. Unfortunately, the outcome has been far from my liking. I recently got word they are not paying up for any of the dermatological services. So perhaps the fact that a PR person contacted me was significant because in the end, it has panned out as a typical PR move: all gloss and lacking substance.

What now? I am moving to an internal BCBS appeal process and if that does not work, I will move on to small claims court in NYC and perhaps a more organized web campaign. In the mean time I have basically have decided to blog about the process so look out for future updates!

Not so long ago, I blogged about my trials and tribulations with Blue Cross Blue Shield of NJ. I got a very interesting response that I will blog about later today or tomorrow, though I can’t say the outcome has been to my liking.

While my problems with BCBS have not reached the status of truly horrific, I do think they are indicative of the how many insurance companies operate: with total lack of transparency and often, integrity (again more on this later).

For those of you who have had horror stories, Michael Moore is now calling for collecting your horror stories as a consequence of the American health care system and health insurance companies. Do take the time to make a video if you have a story to tell.

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