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.

$ 5000 medical bill (that insurance won’t pay for)
$ 450 water bill in Puerto Rico
$ 150 library fine for one lost book that normally costs under 20 dollars

Anxiety and rage from dealing with these ludicrous bills: priceless.

Ok seriously I am now dealing with these three things and it has been really really really unpleasant. I sometimes wonder if I was once a bad as* Roman tax collector by the name of Biella Plebius and now, reincarnated as Biella Coleman, I am suffering the karmic consequences of extorting people in the 3rd century A.D.

Other times I take a lighter approach to all of this and console myself that if nothing else, I am learning a lot. For example, as I had mentioned awhile back, Blue Cross Blue Shield Horizon of New Jersey is stalling and denying health insurance bills for my mole surgery. Because I had a pre-existing clause in my contract, they are trying to squirrel out of it. However, since I never had a pre-existing issue with moles, I am pretty sure they are required to pony up the cash but getting them to do this has been a Herculean, no Sisyphean task.

Since it was clear they were not going to pay if I alone was applying pressure, I was about to file a claim in Special Civil court (the bill is too high for small claims court) but I wanted to see if I had any other options. So hours and hours after diligent web research, I finally found on lawyers.com that I can file a complaint against my health insurance via the Department of Banking and Insurance. I am amazed that NO ONE in the doctor’s office, including those whose only job is to deal with health insurance, had a clue about this option.

And even when you go to the Dept of Insurance website it is not totally obvious that you can file a complaint (it is under the “file for assistance” category). But once I got in touch with them, they have been incredibly helpful.

Now, my detailed complaint letter is with them, and some other documentation and apparently they have an investigator on the case. I am not sure if this route will be enough pressure to get the job done but at least by the time this is over, I will be in the greater NY area so that I can move to the court option.

The take away lesson here is that if you are having any trouble with claims and health insurance, do do do do file a complaint with your state Department of Banking and Insurance. This is a great first option to use.