Actually, granny rage against the machine….

I am helping to kick off the Decoding Liberation Book Launch Party at the Brecht Forum in NYC. If you are in the area, and are into the politics of free software, do come along. Details also pasted below as their webpage is a little bit of an aesthetic jumble.

The Brecht Forum invites you to celebrate the release of Decoding Liberation: The Promise of Free and Open Source Software, by Samir Chopra and Scott Dexter, published by Routledge in their New Media and Cyberculture Series.

October 3rd, 7:30 PM
451 West Street (between Bank & Bethune Streets, New York, NY 10014.
(212) 242-4201
brechtforum@brechtforum.org

Suggested Donation: $6/$10/$15
Free for Brecht Forum Subscribers

Featuring commentary by Gabriella Coleman and discussions with the authors
and audience.

A reception will follow.
(more…)

Fair use is a small oasis in copyright law that allows you to quote, copy and engage with small bits of copyrighted information usually in the service of education, learning and critique. Despite what I think of as an oasis that is far too small, the economic impact is far reaching, at least according to this report, the first of its kind.

Get your documentary on.

See the video. I was lucky enough to be there and yes, the meal was deliciiousssssssssssssssssssssssssss.

Don’t you just love leaked corporate memos?

I do.

They are a window into that which we KNOW exists, yet we are not privvy to very often. Because corporations like to keep their dark, dirty secrets well hidden. Memos give us access to what I call in High Academic Jargonese “Corporate Psychological Interiority,” or to put in simpler language: memos allow us to see corporations crapping in their pants. Gross, but pleasant to see from time to time.

I just got word of leaked memos from the Insurance Company I love to hate: Blue Cross Blue Shield.

The four pages are chock full of interesting stuff, so take a read for yourself. Here, I will only highlight two things:

* Horizon BlueCross/BlueShield is picked out early in the film in a collage of stories citing bad
treatment of members.

And well, as most readers here know, I concur. Well at least
Blue Cross Blue Shield of New Jersey/Horizon can be proud for being one of the worst.

In their concluding talking point sections, they say:

2) The Blues recognize the need for improvement of both the coverage and delivery of healthcare.
But the divisive tone set forth by Michael Moore and his movie “Sicko” is not helpful. Positive
change to our healthcare system can be best achieved through shared responsibility, not
recrimination. To ensure Americans have access to the best healthcare that is both timely,
efficient, and of high quality, requires the collective contribution of all stakeholders –
consumers, providers, employers and the government.

Try NOT being angry at a 4,000 dollar bill or worse, an 80,000 dollar bill, or even worse a death.

It is near to impossible to stop the rumblings of anger. We are human beings, after all. We are born with the capacity to think and feel, passionately and deeply.

And some of the best change comes from the fire that is anger and I hope that enough Americans are finally feeling the fire.

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.

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.