I got a fun surprise over the weekend: my healthcare.gov BCBS policy was cancelled sometime between Thursday morning and noon on Sunday. This is even better as all of my prescriptions are due for their end-of-the-year refill and I’m supposed to be starting physical therapy for a frozen shoulder on Wednesday.
The policy was paid by direct deposit in full at the start of the month, and I have received no warning letters from BCBS. The weekend crew couldn’t find anything wrong with my account or give me a reason why my coverage was terminated, so I get to call back on Monday and find out what got messed up this time and how long it’ll take them to fix it.
On the plus side, the website says my 2017 plan is paid and fine, so worse comes to worse I can just wait three weeks and miss out on deductible-free prescriptions.
This is the third year in a row (once on a private policy, twice on healthcare.gov) that BCBS has “accidentally” cancelled my plan. The first time, they quickly identified the error (a phone payment was applied to the wrong account number) and had it fixed in a week. The second time, the funds were credited to my account but for the wrong year, and it ended up taking three agents, two supervisors, and finally a manager five months to get everything corrected. During that time, I continued to pay premiums but was on an “administrative hold” where I couldn’t see any doctors and all prescription requests had to be approved by hand because each time they tried to reinstate me, the automated systems would identify a discrepancy in my account and would re-cancel my coverage. No one could ever figure out why, when the original payment error was in 2015, the system kept cancelling the 2016 policy (different plan, different account number) instead.
Has anyone else noticed an increase in insurance errors since switching to the marketplace? We’ve had BCBS since I was in elementary school - it’s the only major provider for this region - but we’ve never had errors like this before.
I am horrified, but not surprised, to hear your story, and I hope you are able to get this cleared up yesterday. It’s not your imagination: my daughter has BCBS coverage, I had it for many years, and it has slowly but surely fallen to crap. But this is not specific to BCBS or because of the switch to the marketplace. It is now an American epidemic.
Three words:
Damned Health Insurers
They have become the bane of my existence, both as a physician and as a patient. They cause me to cry each and every month when I undertake the 2- to 5-day ordeal of trying to pay for and pick up my daughter’s insulin. I exaggerate not.
I wish you the best of luck and please keep us updated.
The powers that be in congress want to rescue us from faceless government bureaucrats and put health care in the hands of the private sector. @Lainey I think your experience shows this promised healthcare nirvana is probably an illusion. I hope your problem gets solved promptly this time.
In my experience a bureaucrat is a bureaucrat the difference is that the private sector ones have the profit motive behind their intransigence in addition to the normal bureaucratic inertia. I’m not sure that’s an improvement.
I did after the second error kept dragging on… The assigned agent had a 5-minute phone interview with me and I sent him copies of the payment documentation I’d provided to BCBS. A month later, he sent me a letter saying that because the cancellation was accidental, due to a computer error, and BCBS was acting to resolve the problem, there was nothing they could do and they were closing my file.
Once again, not surprised. What I can’t understand is that I encounter a “computer error” every single month when I try to pick up my daughter’s insulin. These health insurance folks are nothing if not creative: they’ve come up with a uniquely different or combination of different “computer errors” every month since my daughter’s diagnosis almost 3 years ago.
Because of the profit incentive the only patients they want are ones who pay and never file any claims. It’s to their advantage to put up roadblocks so that eventually you leave out of frustration.
I don’t believe things would be so bad if the insurance market was was a truly free market, unfortunately they have an anti trust exemption that dates back to WWII. During the ACA debate ending the anti trust exemption was on the table, but the insurance lobbyists made sure it it never made it into the law.
This little “game” has become increasingly frustrating and I now feel hopeless about ever being able to call in a refill, wait 2 to 3 days, go to the drive-up window, give them a great deal of money, and leave with a few vials of insulin for my daughter. I have lost my proverbial $h!t the past 2 months and counting and our pharmacist is now afraid of me. I get a little more upset each month. I believe I might have even used the “F-word” during my latest desperation-driven and rage-filled interaction with pharmacy staff. I think our pharmacy keeps security on standby when he knows I am coming in to pick up my daughter’s insulin. (Note that I never go to the pharmacy until after I have made several phone calls, including to the pharmacy, during which I am assured that everything has been straightened out and that there will be no problem whatsoever when I go to pick up her insulin.) This recurrent process is making me question my own sanity.
And after an hour on hold and being hung up on twice, I got a live person! Once benefit of last year’s ordeal is that I immediately got bumped up the chain after I gave the ID number and said it was a continuation of the same problem.
The manager claims that while there was an error with the 2016/2017 payments, it had already been caught and corrected and is just “taking a few days to work through the system.” Same story as last year about how the user website doesn’t show the same databases as what the medical offices use, so even if I see the account as being cancelled the practice will be able to confirm that I’m covered. She did put in an override and directly call the Express Scripts team to get the refills processed, so that’s one hurdle down.
Now I get to spend three months waiting to see if (a) the website corrects itself and (b) if I get a call from the Audit team in the spring saying that they made a retroactive determination that I really didn’t have coverage in December and need to reimburse BCBS for the services I received - just like last year.
I think that a state insurance commissioner’s office inquiry into your situation may focus the BCBS management’s attention to really fix your “problem.” These organizations do understand a threat of real-world power much more quickly than an irritated client who they can run through the customer service wringer and hopefully wear them out.
It probably depends to some degree on what state you live in. I happen to live in a “regulatory capture” state, where the insurance commissioner is a past regional manager of the state Blue Cross office. Threatening BC with the commissioner probably wouldn’t accomplish much here.
There is some kind of variability in all this that I don’t understand. We had Blue Cross Idaho for years under both ACA and employer provided-plans. They were garbage, and we’re still sorting out the same kind of shenanigans (canceled coverage, denied claims, claims of ignorance from the staff, computer error, etc.) as OP is experiencing. However, I recently switched to a federal BCBS plan (out of Oak Ridge NL in Tennessee). BCBS Tennessee has been nothing short of amazing from the get go. No issues, better coverage, made exceptions to the “preferred formulary” with nothing more than a phone request from me, etc. The premiums are high, but the quality of service and the quality of the services delivered are the best I’ve ever experienced.
So I’m not sure why a company like that varies so much from place to place.
David49, my daughter’s BCBS coverage is federal. It used to be okay, but BCBS, along with every other private health insurer, has been slowly but surely gravitating to The Dark Side. For quite some time now, I have had to spend an ever-increasing percentage of my time wading through their BS, time for which I am not paid. When I first started practicing medicine, perhaps less than 5% of my time was spent playing games with health insurers. It has recently reached the 55% mark and is climbing. So I spend up to 40 hours per week trying to make patients’ health insurers cover part of the cost of decent health care and meds, and I receive absolutely no pay for this time. I’m not trying to say I’m Mother Teresa or anything, because I believe the majority of physicians do the same. Something has got to change, or soon I will have to worry about not making enough to cover business expenses, a roof over my daughter’s head, food in her mouth, and insulin in her subcutaneous fat.
Yeah, I know the current US insurance scam is the worst thing to happen to healthcare in a modern nation, well, ever. I’m sorry it’s such a pain in the ■■■ both personally and professionally! That’s sad to hear about the federal BCBS. My experience with them has so far been very positive: I suppose I’ll look forward to them being just as sad-sack as BC Idaho.
