Countless phone calls.
Dozens of emails -- including to the president of the company.
A complaint to the Better Business Bureau and the State Insurance Commission.
All of this effort, just to make Blue Cross pay a $2300 bill.
And today, I won.
It started seven months ago.
My dentist told me I needed to have my wisdom teeth removed. He sent me to the best surgeon in town. The procedure was complex and ugly -- apparently, that's what happens when you wait until you're 30 years old to have your wisdom teeth removed.
But it all went well, and, $400 poorer -- that was my share of the insurance payment -- they sent me home with a box of gauze and a bottle of Vicodin.
And then the madness started, which I described in August.
Bottom line: I spent five months trying to get Blue Cross to even acknowledge it had received my claim and then to actually process the claim and then to actually send a check to pay for the claim.
I got nowhere.
Except for one thing: I got the name of the vice president.
And with his name, I could figure out his email. Because, like many large corporations, the email formats are the same for everyone.
So now I could email the vice president directly.
And the vice president apparently does not want to waste precious time dealing with a $2300 claim. So he directed his staff to look into the matter. Immediately.
But that, apparently, was not enough.
I sent several emails to the vice president, asking him to use his authority to immediately direct his staff to pay my bill.
But apparently, that wasn't enough.
So, with the help of Google, I got the name of the CEO and President of Independence Blue Cross.
Same email format. FirstName.LastName@ibx.com.
And as much as the vice president resents wasting his time on a silly little $2300 claim, the President really doesn't want to waste his time.
So he had the Senior Director in his office contact me. Immediately.
She was very concerned about my complaints regarding the way Blue Cross handled -- or, rather, mishandled -- my claim. The President's ofice was launching an immediate investigation into the matter, and I would hear from Blue Cross within a week.
But, just to be sure, I also filed a complaint with the Better Business Bureau.
And, just to be extra sure, I also filed a complaint with the State Insurance Commission.
Funny how seriously they take you when you go directly to the top and starting filing complaints with outside regulatory agencies.
The Supervisor of Executive Inquiries sent me a seven page letter. It included this admission:
Unfortunately, when our claims processing services division initially finalized the claim, it incorrectly denied benefit consideration...and incorrectly requested that you provide an EOB from your primary carrier. Again, this was not the appropriate response to your situation.
The astonishing thing about this letter was that although Blue Cross admitted to making certain mistakes, ultimately, it still felt that it was justified in paying only $460 of my $2300 claim.
So I demanded an appeal of the decision. And I wrote a seven-page letter back.
I quoted each portion of the letter from Blue Cross that was false and inaccurate. I had 10 pages of typed notes detailing each and every conversation I'd had with each and every employee of Blue Cross.
I had all the facts. And they were wrong. And I could prove it.
As an added precaution, I sent a copy of that letter to the State Insurance Commission.
I received a call from the investigator at the Insurance Commission. He would look into whether my claim was properly processed, but as to the larger issue -- the issue of whether Blue Cross engages in unfair business practices as a matter of course -- well, sorry, but he's got a whole pile of cases to cover and frankly, Blue Cross is a very good company and his department simply doesn't have the time or will to launch a full investigation into potentially fraudulent and illegal activities by Blue Cross.
Some regulatory agency, huh?
This morning, the Appeals Committee was supposed to meet for a second level review of my claim. I was ready with all my notes and all the letters and all the emails.
I was ready.
And then the call came.
The committee met and reviewed my file and my seven-page letter and my complaints to the Better Business Bureau and the State Insurance Commission.
And the committee decided to overturn its prior decision.
The committee decided that after five months of pretending it didn't have the correct information, a few weeks of pretending it had sent me a check that never arrived, and two months of pretending that its tiny portional payment of my claim was justified because my doctor wasn't "in network," Blue Cross would finally -- finally! -- treat my doctor and my claim as "in network."
And Blue Cross is sending me a check.
So, if you are doing battle with your insurance company, allow me to offer a few suggestions:
1. Keep detailed, contemporaneous notes. Every time you talk to someone from the insurance company, keep notes during the conversation. Blue Cross's file was rife with inaccuracies, and I was able to point out each and every one of them, to Blue Cross and to the outside regulatory agencies.
2. Work your way up the chain of command. The people sitting in the cubicles getting $8 an hour have no authority. Their job is to lose and deny your claim. That is what they do. So ask for their supervisor. And then ask for their manager. And then ask for their director. And then ask for the vice president.
It won't be easy. They won't just transfer you to the vice president. But get the names of everyone in charge, and you'll be able to track them down. You can figure out their phone numbers and their emails. And they are the ones with the authority. And, considering how much money they make, it is simply not cost effective for them to waste time fighting with you on your claim. They want their staff to handle the situation promptly if for no other reason than to get you to leave them the hell alone.
3. File a complaint with the Better Business Bureau. You can Go to the Better Business Bureau. You can file a complaint online. It's easy. The BBB will contact the insurance company, and the insurance company will have to respond. The insurance company will probably insist that it is handling the matter. You'll get a letter from the BBB asking if the situation is resolved.
Say no. Do not let the BBB close the case until you get what you want from your insurance company. The BBB will continue to send letters to the insurance company, and the insurance company will continue to expend time and money to respond to the BBB. The more resources of the insurance company you consume, the more motivated the insurance company is to resolve the matter.
4. File a complaint with the state insurance commission. You will need to file the complaint with the state in which your insurance company is headquartered. Although I live in Washington State, my insurance is through Independence Blue Cross of Pennsylvania. Washington State has no jurisdiction.
If my experience is in any way indicative of the way the insurance commissions typically handle such complaints -- and I'm pretty sure it is -- the investigator assigned to your case will be overworked, underpaid, and won't give a shit whether your insurance company engages in unfair practices. But that doesn't matter.
Because the investigator will still be required to send a letter to your insurance company. And your insurance company will still have to expend resources to respond. And your insurance company does not want to spend its time and money responding to your complaints. So the more complaints you file, the more motivated the company is to resolve the matter.
5. Don't give up. They will try to wear you down. They will bounce you from department to department. They will say they never received your claim. They will say you sent it to the wrong place. They will say you are wrong. They will say there is nothing they can do. They will tell you to read your contract. Heck, they might even send you big, thick copies of your contract to prove that they are right and you are wrong.
But don't give up. That's what they want. That's how they make their money. That's how they win.
Do not let them win.
Fight them every step of the way.
And you can win too.
If you are having problems with Independence Blue Cross in Pennsylvania, email me and I will provide you with the contact information for all of the appropriate people: the president and his senior director, the vice president, manager of the appeals department, and several other useful names.