There are two topics that seem to receive a steady stream of comments on this blog. My entry on Edmonton garners a smattering of comments every few months, usually giving E-town a huge thumbs down. The other entry concerns my tribulations with BCBS and here I receive a steady stream of sad stories all of which point to the horrors caused by some branch of BCBS such as my least favorite one Horizon Blue Cross Blue Shield of NJ.

Along with the comment posted above, I got this one asking me to reveal the email address of the PR director of BCBS NJ. In the past I advised folks to google it to find it. But I just tried and it is actually a bit harder to find and I wonder if I should post to one of the many press releases that exist on the web with this information?

I hope thats some with some sort of time and lots of anger (toward BCBS) to start a website specifically geared toward and against BCBS. Call it Blue Cross No Shield (I think I actually own that and am pretty proud of the name) or something of that nature and throw up some blog and post horror stories in the style of the consumerist. There will be no shortage of them, especially if the blog is national in scope.

Get a mailing list going and start a fax campaign among many others. Share contact information about public relations directors and Other People in Power, tips and advice on fighting them, and perhaps even move to the next level of organizing.

I am not sure writing this here will do anything to inspire other and I would love to do this sort of rabble rousing as I get immense pleasure from doing so. But I simply am in the red when it comes to time. But I hope that some of the folks that have posted comments on this blog take the initiative to start a larger campaign (or someone can point me to an exisitng one).

update: Now that I think of it, The Consumerist should really take up this cause and devote a section JUST to health insurance. They are already a brand name of sorts with lots of eyeballs on the site, everyday.

So I am still getting a lot of comments on my blog about BCBS horror stories and recently this one was submitted, which seems particularly horrific:

I had an accident in June. I was rushed to the emergency room on a Saturday afternoon. An Orthopaedic surgeon that was on call came in to set my bones. BCBS says that the physician was out of network and they paid $3900 of a $21,000 bill. I had NO choice and I was not in any shape to find out if the doctor was in-network. Seems illegal to me.

Wow. I also got an email from someone else also undergoing some horror who has asked me for the email of the public relations director who had emailed me many moons ago. Normally I would feel somewhat guilty giving it out, but given that BCBS is seriously causing a lot of problems for people all over the country, I think it is important that top executives in the company know they are causing havoc and financial problems for scores of peoplethis one is pretty horrible as well . Second, the information is already public and so one can easily find this person’s name by googling BCBS Horizon public relations director (You will get his name) and then google his name and you will get his email and phone number.

Good luck. If I were not a professor and were financially secure, I would definitely spend all my time on health insurance reform activism (and kick some serious ass, since I really enjoy that type of political work). In the meantime, I will help in the little ways I can and hope that this administration, which is a vast improvement over the last, will also rattle the health insurance industry as well. There are also groups out there doing great work, so if you are into reform, do lend them a helping hand if you can!

After two years of phone calls, nasty emails, filing claims and reports, Blue Cross Blue “Shield” of NJ finally ponied up every last cent of cash they originally did not want to pay. Since the ordeal began, many BCBS customers left comments here where I chronicled my plight and many have also sent me emails as well. In the end, I think I was successful mostly because I had the email of the director of public relations (he made the mistake of emailing me) because well, I would send him these emails and I think he just did not want to receive anymore.

Recently I received an email from Reynold Weidenaar with a pointer to his webpage where he is also chronicling what is happening with BCBS since they want to deny coverage for physical therapy. This is great and more folks need to do this exact thing, which is chronicle every last detail in a public place. In the end, they have a lot of paperwork and we need to turn it back to them and in very large numbers.

Anyone who knows me, even remotely, knows that I have a huge beef with the American health insurance industry, which was greatly magnified after my own unpleasant run-ins with them over the course of the last two years. But of course while the insurance industry is certainly a ruthless predator and thus deserving much of the blame, they are not the sole culprit in sustaining what is a lousy health care system for Americans. A key player, I think, are American doctors, and I would now like to spread that beef patty of disgust to them, especially since they are now the one’s giving me problems dealing with the final portion of BCBS bill. The story is indicative of lager issues and problems that center on the problematic silence “spoken” by doctors.

To make a long story short, BCBS of NJ was not ponying up some serious cash (at least for me) for 2 mole surgeries because they were claiming it was pre-existing condition. After having the public relations director email me (thanks to that post) and a lot of research and letters etc, it was more or less resolved. Soon after they overturned the pre-existing “bs” (and I am not talking blue shield here), they promptly started to pay all sorts of bills (and I even got money back from doctors I had paid).

But there is one pesky $1600 bill that lingers like a bad smell and the question is why? I am not entirely sure but my interactions with my ex-dermatologists, Affilated Dermatology in NJ, I think reveal some important lessons as to why and how the medical establishment are complicit.

Basically, BCBS is telling me that it looks like they have been double billed because the cost is exactly the same for two procedures that are also exactly the same. I explained that I had did indeed have two surgeries on my scalp (they were really close to each other) and they let me know that the provider needs to call back and send information that clearly shows there were two surgeries. This actually seems somewhat legitimate and potential mistake (and it is not like medical billing is known for their lack of mistakes and integrity either).

So I call Affiliated Dermatology and while I would say they have been patient, in so far as patiently waiting for my money, they have been completely unhelpful in any meaningful sense to help me getting this resolved. Now, given how difficult it is to deal with the health insurance industry, I understand they can’t provide fine-tuned, fine-grained personal attention. The health insurance industry engages in some real hefty politics of foot dragging and well, there are so many foot soldiers at doctor’s offices to keep up with the web of knots that the health insurance constantly entangles us in. With that caveat in place, they can however do two things:

1. Inform you that you can contact the Department of Housing and Insurance and start some sort of formal complain process.

2. Give you some small clue as to whether the doctor has sent any of the additional requested information (they are usually mum, or enigmatic, or totally confusing with regards to that) so you know what the heck is going on.

So a few days ago when I was speaking with health insurance person at the dermatology office, she claimed there was nothing else she could do about this last bill. Every time she calls BCBS, she claims that they claim it is a problem with being a pre-existing condition, and I was like “how can that be when that has been cleared and every other bill, and there were many, has been paid?” And then she also said that there has never been this confusion before where 2 surgeries look like one, blah blah and blah (and in retrospect, I forgot to tell her that my double surgery, according to the doc, was in fact highly unusual, because they would usually do them on two separate days because they were so close to each other. They made an exception because I was literally on my way to Canada and begged them to do so but anyway).

Ok, so there I was bickering with this woman and feeling stuck between a rock and a hard place. Finally I let her know, point blank, that they have been remarkably patient with the billing but totally unhelpful in, well, helping me out. I let her know that they should let people like me know, for example, that they can file a formal complaint against the health insurance company and this would at least get the ball rolling. I then let her know that I had no other option but to file another complaint with the Dept of Banking and Insurance and they would just have to wait for that, at which point, she all of a sudden became more helpful. She suggested that we can do a three way call to resolve this. Well there you go. Why did it take a heated 15 minute conversation topped with a threat to get what I think actually makes perfect sense? Get the 3 parties involved on the phone with each other so as to all get on the same damn page about what needs to be done (not sure if BCBS will agree to this… at which point I will pester the public relations director again and in the end, I think this was resolved because he was sick of my emails).

Now, why why why why why why are doctors and their staff so unhelpful? I think that main answer is they are overwhelmed and don’t have the staff to deal with the enormous amount of foot dragging and coy tactics deployed by the health insurance. That said, there are 2 things worth mentioning that I think don’t paint a very flattering picture of many American doctors.

If you pay attention to your medical bills (and you always should), it is immediately evident that the doctors and hospitals get paid LESS, sometimes a lot less, if the health insurance company foots the bill because of the pre-arranged negotiated rate. So there is an actual incentive on that side of things to get paid via the consumer as opposed to the health insurance company. Now. I am sure that there are health care economic studies and reports justifying this strangeness but that does not make it right either. There is a clear incentive in place to get your green dollars, as opposed to those of the insurance company.

Second and this is a much bigger issue, is that I think that for any meaningful change to happen, we need the active support of a large percentage of the medical community, especially doctors. If they are mum, or actively opposed to health care reform (as was the case when the AMA helped derail the Clinton effort at instituting universal health care in the 1990s), well then it becomes all that much harder for the general populace and the politicians to initiate real change. Doctors are the ones, after all, with the moral weight and capacity to make claims that can STICK. If they are saying this system negatively impacts how we care for the ill, it is a system that is is immoral, well, one should listen to them as they are the ones, after all, who dedicated their LIFE to healing the ill, right? Yes? No? Maybe?

So their silence is nothing short of grave. The good news is that it seems like more doctors are on board than ever before clamoring for change in the right direction, but we need a lot more to come aboard…

A number of years ago, I wanted to write a controversial and critical article that claimed hackers are more ethical than doctors. I thought it would be fun to claim that those who are usually seen as ethical (doctors) are less so than those that are usually portrayed as bad-as* unethical tricksters.

Some people were offended by this because doctors deal with the great burden of life, death, sickness, and thus suffering while geeks and hackers are “just” geeking out on their computers. True. But at least a cadre of hackers have sustained a social realm and a real ethics–free software–in order to guarantee their own autonomy and also create the conditions for what is right for software.

Doctors, on the other hand, do not carry the torch of ethics as they should. While individually I am sure they deal with a oodles of difficult ethical choices and decisions, it is about time they they turn as a collective to the larger structural conditions that seriously cause a lot of harm to millions of Americans, especially the droves of uninsured. They have the moral weight to do something about it and it is about time they carry their weight in this battle and take some burden of suffering off others.

So here is a real (and positive) update.

So today I was on the phone with a very kind BCBS employee to schedule an in-person appeal meeting where I would present my case to a group of doctors (not affiliated with BCBS). Thankfully on the phone she mentioned that the only pre-existing condition left was an allergy and I was like, “no, how about all the skin stuff?” (this list is too long to list) and she was like all of those were overturned in August and so are not considered pre-existing conditions.” I was shocked and thrilled. She then faxed the letter that never got to me because it was sent to an old address in NJ (that I had changed this summer) .. So now we are moving somewhere good…

More soon but I wanted to pass on the good news!

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It is clear to me that a “clearinghouse site” for complaints against Blue Cross Blue Shield would yield a lot of traffic. My post complaining about my problems with BCBJ Horizon of NJ has received constant comments with people posting their horror stories.

I have not moved to create such a site yet, because I am hoping that the outcome of my appeal will be positive and that I can report that going through the appeal process as they set up can lead to fair and just outcome.

But the frustrating thing is 3 emails and 2 phone calls placed this and last week to inquire simply about the status of my appeal has been met with a wall of silence. Frustrating…. I am going to try to contact them again this week and if not… I will have to file another complaint with the dept of Banking and Insurance over their inability to respond to me about the appeal process.

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.

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!