Two nights ago I was having dinner with a colleague who recounted a truly horrible experience he had with the modern-day American health care “system.” While in Montana over the summer, he got bit by a bat and well, as a result, he and his entire family had to get rabies shots. These shots are hard to get and priceeeeeeeeeeeeeeeeeeey. The final bill was $ 20,000 and his NYU based health insurance, United Health Care is claiming they are not responsible!### Like getting bit by a bat and the possibility of rabies are not bad enough. Isn’t the point of health insurance to take care of the unexpected??

Someone also pointed me to The Daily Kos’ wrangle with BCBS of California and well, they picked the wrong guy to mess with given there are so many many many many eyeballs tuned to his blog, everyday (just check out the number of comments). I wonder if the public relations director will contact him as they did with me after I blogged about my trials and tribulations. I certainly don’t have the audience and readers he does, so I am always surprised they ever contacted me in the first place.

The Daily Kos also provided a link for a site that I was thinking of creating if my problems with BCBS were not solved (glad to see someone else has) called Sick of Blue Cross. I personally like the name I came up with a little better Blue Cross No Shield but the important thing is that a site like that exists and it is very good site, design and content wise. There should be a site created for every health insurance company and they should federate and pool resources to gain more visiblity.

While I am not hopeful that the health insurance industry will change within, I think mounting and steady consumer pressure can do a lot to force the industry to change their awful ways. And while I think the bad publicity is a key part to putting pressure on the health insurance to change, I actually think that the power of the consumers also can come from elsewhere, and this elsewhere is overwhelming the administrative channels within and outside of the health insurance. The gist is if they send us a lot of (useless) paperwork, send them A LOT of paperwork back.

On the Daily Kos, a lot of people noted that things got moving when they complained to the Department of Banking and Insurance. While my own complaint to that department did not produce any immediate fruit, it did get the ball moving for the appeal process, which eventually panned out for me. That is, I learned a lot and started to get decent customer service. Doors opened.

Now, it took me weeks to find out that I could complain to the Department of Banking and Insurance and I am sure many find themselves in that situation of walking in a no man’s land of confusion and frustration. If more and more people know that you can file a complaint to these Departments (and why are doctor’s offices not relaying this information??!!), they and the health insurance companies will get inundated with that which they love to inflict on us, paperwork.

This may slow things down for you but at a certain point, state governments will get the message that something is deeply wrong. So, people MUST use these channels and overwhelm these agencies with complaints, faxes, emails as this is a powerful and very material message that something is deeply wrong and broken and must be fixed.

Also, send faxes and letters to various departments in your health insurance company (appeals, customer service, medical director’s office, public relations office…) get people’s email’s and send them emails. Inundate them with a barrage of administrative paperwork. If they are not being helpful, send a fax or two a day concerning your case until you get clear answers. While individual faxes won’t make much of a difference, imagine if there are 300 a day coming in or 3000…. This can work with the numbers are there and I have a feeling that the numbers Are There.

So spread the word for housebreaking your health insurance and push the paperwork back on them.

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.

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!

$ 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.