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Seven months.

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.  

FirstName.LastName@ibx.com.

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.

I won.

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.

Originally posted to Kaili Joy Gray on Fri Oct 24, 2008 at 10:42 AM PDT.

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Comment Preferences

  •  wow, way to go angry mouse... (4+ / 0-)

    Reason #200 for having a universal health care...  Looks like they messed with the wrong person this time..  Sure a lot of people just don't have the patience or know how to fight it like you did.. Tip/Rec'd..  

    "If a free society cannot help the many who are poor, it cannot save the few who are rich." JFK (1917-1963)

    by ebbinflo on Fri Oct 24, 2008 at 10:46:29 AM PDT

  •  Good job! (6+ / 0-)

    Only problem is... to be be able to deal with insurance companies, one needs lots of health...

    •  Very true. (5+ / 0-)

      And I'm lucky.  My surgery wasn't a matter of life and death, and the bill, while inconvenient, wasn't going to bankrupt me.

      But it just proves how desperately we need to get rid of the health insurance industry.

      Enjoy it now, Sarah, 'cause we're kicking your silly winking folksy lipsticked ass back to Alaska. For good. Also.

      by Kaili Joy Gray on Fri Oct 24, 2008 at 10:52:23 AM PDT

      [ Parent ]

      •  It'll never happen for one big reason--JOBS. (1+ / 0-)
        Recommended by:
        Angry Mouse
        •  Which is why we need to invest in and create (2+ / 0-)
          Recommended by:
          kalmoth, Angry Mouse

          new industries, that are not based on BS. And the health insurance industry is based on BS. I don't want to see anybody out of work, but having whole categories of jobs based on making sure that people are not able to get healthcare when they need it does not seem to be wise, fair or healthy.

          There is so much else that needs to be done in this country, and whole new categories of industry that could be built. If we were to get creative and innovative at long last, we could get rid of the health insurance system and instead just have both jobs and health care.

          I trust the Obama-Biden campaign. These folks know what the hell they are doing.

          by Jennifer Clare on Fri Oct 24, 2008 at 11:33:23 AM PDT

          [ Parent ]

          •  Exactly. (1+ / 0-)
            Recommended by:
            Jennifer Clare

            Instead of Camille the supervisor sitting in a cubicle at Blue Cross, let her sit in a cubicle at the new Solar Energy Plant or the Wind Energy Plant.

            Customer service is customer service.  I'm sure she doesn't give a shit which company signs her paycheck.

            Enjoy it now, Sarah, 'cause we're kicking your silly winking folksy lipsticked ass back to Alaska. For good. Also.

            by Kaili Joy Gray on Fri Oct 24, 2008 at 11:40:42 AM PDT

            [ Parent ]

          •  Right on, but it's one of those "changes" (0+ / 0-)

            that folks are so resistant to.  For my part, I can sometimes feel a little less guilty because I work for hospitals that are trying to collect FROM the insurance agencies.  Still though, the hospitals are a cog in the whole big system.  It's great that the hospitals can make enough money to hire a bunch of administrative paper-pushers to actually collect reimbursement, but it's also not much of a choice.  And it's not just the insurance companies; Medicare and Medicaid are among the most difficult to collect from.  

            And the healthcare industry is reaching out to so many other areas besides the obvious.  Technology and information systems companies are highly attached to the medical field; 3M is one of the biggest profiteers because of the emerging medical coding and billing systems.  

            It really sucks but the entire industry is soooooo entrenched that it really does create so many jobs it would be nearly impossible to unravel.  

            •  Well, I worked in the healthcare industry (2+ / 0-)
              Recommended by:
              kalmoth, Angry Mouse

              for about 10 years on the equipment manufacturers', pharma distribution and technology side. And while I have seen first-hand how huge these companies are, I have also seen how wasteful they are. And how willing they are to lay off workers at the first sign of a quarterly fall in profit or shareholder stock values.

              The whole system is screwed up, and I say, let us as a country invest in new businesses that create jobs and actually do something useful, and dismantle this whole ridiculous system of health insurance. The health insurance industry is killing people. Literally.

              I trust the Obama-Biden campaign. These folks know what the hell they are doing.

              by Jennifer Clare on Fri Oct 24, 2008 at 11:52:18 AM PDT

              [ Parent ]

              •  I really want to see it changed too. (0+ / 0-)

                However, it's a logistical nightmare.  For me, just thinking about what to do with the people (like myself, my coworkers, my own mother) currently in these positions, makes my head hurt.  It's a Catch-22 loop that is not going to have a quick or simple fix.

                Do we cut off these jobs now and have millions of people unemployed until those new jobs are ready--because I imagine it wouldn't be literally ready to go tomorrow if implemented--or do we set up the new system in the meantime and keep those people working in health care until then?  I mean, this is maybe a shallow point, but it's a severly complicated problem that's only getting stickier and more complex by the day.  

    •  ...The Rainmaker... (1+ / 0-)
      Recommended by:
      kalmoth

      and to think that movie is like 15 years old...and we are still up to our necks in this bullshit.

      Nothing has changed.  We need fundamental change.

  •  daym woman! (or is it man?) (4+ / 0-)

    sorry. I applaud you, commend you, tip you, and rec you. shit.

    so... are they gonna compensate you ALSO for the hours it took you to achieve this? I always calculate $10/hour for Stupid Waste Of My Time stuff. Okay Im kidding, but we should be able to do that. (Comcast owes me about $200 at this rate, right now.)

    Another way... use the shit out of whatever coverage youve got, especially dental. Every three months, and see if bx will pay for you one of them Sonic toothbrushes too. er sumthin. gah.

    We will end it by telling the truth - forcefully, repeatedly, confidently - and by trusting that the American people will embrace the need for change. 5/6/08

    by Lady Libertine on Fri Oct 24, 2008 at 10:49:57 AM PDT

  •  Good for you! (3+ / 0-)

    My own nickname for Blue Cross of California, now owned by Anthem, a for-profit health insurer, is Evil Empire.  So now you're a Jedi!

    I used to be disgusted, now I try to be amused

    by indigoblueskies on Fri Oct 24, 2008 at 10:50:39 AM PDT

  •  Mouse, this is an invaluable diary, however (4+ / 0-)

    I am so sorry and dejected as an American and as a member of Blue Cross that this happened to you.  Only organized and savvy people who have the wherewithal to persevere in the face extreme indifference can hope to achieve any measure of success.

    Bravo.  I will print your diary and save it, Mouse.

    Dogs have so many friends because they wag their tails instead of their tongues. -Anonymous

    by gloryous1 on Fri Oct 24, 2008 at 10:52:48 AM PDT

  •  Kudos, Angry Mouse! (6+ / 0-)

    The metaphorical slant of "wisdom teeth removal" makes this almost priceless.  Take that, Blue Cross...Angry Mouse's wise and relentlessly persistent fury!

    I hate Blue Cross, but that's another story for another time. On the wisdom tooth removal front, I was in my late 40s when mine were removed.  I thought it was no big deal and told my partner I expected to recover nicely in the afternoon and go to a Sidney Lumet lecture that night.

    Hah.  

    Glad your wisdom teeth are gone; thrilled with your victory.  

    ...just another hooligan from the droogie clique

    by RadioGirl on Fri Oct 24, 2008 at 10:53:17 AM PDT

  •  I also fought Blue Shield in Pennsylvania and won (4+ / 0-)

    It also took 7 months, countless phone calls and some tears.  It wasn't nearly the same cost as yours, but we had already paid $8000 to have a baby, so any claim was worth fighting.  One of the claim agents said I deserved the money and the next agent denied it. Finally they listened to the call and sent a whopping $50 check!

  •  Way to go, AngryMouse! (2+ / 0-)
    Recommended by:
    RiaD, Clio2

    Great information, and an awesome example of how to fight these creeps!

    Additionally, my sympathies on having those wisdom teeth removed after the age of 30--I had to have all four of mine removed in my late 30's and it was not easy. Hope you are feeling better. I definitely felt better once the healing was done after the procedure, but it was, without a doubt, difficult. Fortunately for me, I did not have a problem with my insurer. Of course, now, I don't even have insurance anymore, but that is another story.

    Good on you for being relentless in taking these jerks on!

    I trust the Obama-Biden campaign. These folks know what the hell they are doing.

    by Jennifer Clare on Fri Oct 24, 2008 at 11:04:54 AM PDT

  •  Thanks for this (1+ / 0-)
    Recommended by:
    Angry Mouse

    I will definitely not be switching my health insurance to Blue Cross anytime in the future. (As  gov't. retirees, we periodically get a choice.)

  •  I am never shocked when I hear stories (2+ / 0-)
    Recommended by:
    RiaD, Angry Mouse

    about the insurance industry.  All those hours, phone calls, letters, whatever, to get the coverage you already paid for.

    Obama for change!

  •  I got a specific question about "EOB"... (2+ / 0-)
    Recommended by:
    ebbinflo, Angry Mouse

    In my trails and tribulations I had to get my "EOB" (explanation of benefits) faxed over again and again, EVEN THOUGH every party already had a copy of it.

    Did you run into this?

    What got me is that I asked if the EOB that would be faxed over would be any different to the original EOB that (in my situation) they denied/didn't respect the discounted rate I was to be charged.  They said it would not.  I about blew my head off!

    Did you run into this?  I think it is a common practice that really is a criminal act.

    •  Yes! (2+ / 0-)
      Recommended by:
      RiaD, WattleBreakfast

      They kept saying they'd send it to me, but it took forever to receive.  And then the EOB was just flat out wrong.  It denied my claim on the grounds that I'd had other primary insurance at the time, which I didn't.

      When I called to ask, they told me, "Oh, that was a mistake."

      No shit.

      That was before I got wise and started dealing directly with the president's office.  Things happen a lot faster and better when you're dealing with the president's office.

      Enjoy it now, Sarah, 'cause we're kicking your silly winking folksy lipsticked ass back to Alaska. For good. Also.

      by Kaili Joy Gray on Fri Oct 24, 2008 at 11:14:51 AM PDT

      [ Parent ]

      •  I see your situation... (0+ / 0-)

        mine was slightly different.

        I never asked for my on EOB, I was asked to have my Blue Cross (by the 3rd party actually charging me) send them another copy after another copy.  And was eventually told the EOB that was being asked to be sent was going to be no different than the one they had.

        I thought that was suspicious and it infuriated me.

        And yes, good job on getting to the president's office.  I was dealing with "managers". :(

    •  EOB is such a dreaded term to me. (2+ / 0-)
      Recommended by:
      Angry Mouse, WattleBreakfast

      It seriously makes me cringe. I've spent so much time sending and resending and resending.  One of the things the insurance companies do to buy time is claim they never got the EOB.  Even when you staple it to the damn claim and stamp on the front "EOB ATTACHED" or you fax it and get confirmation that it sent.  It's like giving the ins. co a loan for a month until they get the 2nd sending.  Pain in the ass, seriously wrong.

      •  Tell me about it. (1+ / 0-)
        Recommended by:
        WattleBreakfast

        It took Blue Cross more than three months to even acknowledge receipt of the claim.  

        They said it had to be mailed and they'd give me the address and my provider would mail it.

        Then they'd say they never received it and it had gone to the wrong address.  And of course, even though it's the same company, the departments can't talk to each other.

        And every time I call, I get different information.  Nope, that's the wrong address.  Nope, that's the wrong address.

        So you have no way of knowing if the info you're getting is correct.  And even if they admit was mistake, they'll still insist that everything else they're doing is correct.

        It's a total racket.

        Enjoy it now, Sarah, 'cause we're kicking your silly winking folksy lipsticked ass back to Alaska. For good. Also.

        by Kaili Joy Gray on Fri Oct 24, 2008 at 11:19:23 AM PDT

        [ Parent ]

        •  It is a racket. (3+ / 0-)

          And the sick thing about it is they do this because it is profitable.  How many people do you think just give up and pay the bill?  Enough to make these tactics worth their time.

        •  It is a racket! That is why we have to throw... (2+ / 0-)
          Recommended by:
          Angry Mouse, Lady Libertine

          it out!

          Seriously, I was in Australia for two years and they have universal health care - it is like our Medicare (they even call it Medicare!) but everyone had it, it was not a stigma, it was a given.

          You went to the office with your claim (if it wasn't already taken care of by the doctor's office itself, which was the normal case, because the doctor is required by law to do it and it is beyond simple with one smoothly functioning agency to deal with) and they paid you on the spot!

          You can also get private insurance on top of the guaranteed government "public" insurance there if you so choose.  It was just plain good for the soul to see a system like that.  I cry when I think of the people hurt by our system here.

  •  Nice work! (2+ / 0-)
    Recommended by:
    ebbinflo, Angry Mouse

    Excellent advice.

    Gordon Smith is all "occasionally tolerant-sounding but legislatively meaningless rhetoric." (David Sirota). Vote progressive Jeff Merkley into office!

    by negev79 on Fri Oct 24, 2008 at 11:13:52 AM PDT

  •  MANY thanks for this detailed battle plan. (2+ / 0-)
    Recommended by:
    ebbinflo, Angry Mouse

    I'm just now embarking on a dental reconstruction project partly covered by BC/BS Federal Employee Program. They've been stingy with the small early bills, paying only around 10%, but now starts the major work, and if they don't pay a substantial part, I'll need to rear back and charge at them with the same methodical gusto you've detailed here.
    This will be an invaluable guide. So thanks!

    The important thing is not to stop questioning. Never lose a holy curiosity. Albert Einstein

    by howardfromUSA on Fri Oct 24, 2008 at 11:26:52 AM PDT

  •  Thank goodness we don't have single payer! (3+ / 0-)
    Recommended by:
    ebbinflo, Jennifer Clare, Angry Mouse

    Just imagine;  people receiving care, and having it paid for.  What a radical idea.  What loon would support that?  (/snark)

    I hate insurance companies.  They actually add to general stress, thereby making people sicker.

    When I got rejected by BCBS for what seems to be a very stupid reason, my reaction was "bite me".  No way will I get insurance from those clowns.  Guess I was the lucky one.

    I am become Man, the destroyer of worlds

    by tle on Fri Oct 24, 2008 at 11:30:41 AM PDT

    •  Yeah, can you imagine? (0+ / 0-)

      Sometimes I get off the phone after fighting with the insurance company and I think about how people in other countries with socialized healthcare would not understand the conversation I just had.

      "But you had the surgery?  Why aren't they paying?  Why are you fighting with a supervisor at a corporation about your surgery?  I don't understand."

      Enjoy it now, Sarah, 'cause we're kicking your silly winking folksy lipsticked ass back to Alaska. For good. Also.

      by Kaili Joy Gray on Fri Oct 24, 2008 at 11:33:36 AM PDT

      [ Parent ]

  •  Hard work is an economic cost (0+ / 0-)

    Both you and your insurance company taxed each other to the tune of, who knows, thousands of dollars worth of hard work and pain.

    We need to change the mind set in this country and in this world.
    I might dress up as ghoul this Halloween. I'm thinking Martin Sullivan maybe.

  •  Also, don't forget the news media! (1+ / 0-)
    Recommended by:
    ebbinflo

    Insurance companies hate it when reporters start asking questions that might damage the company's reputation.

    Anyway, great work!

    •  That was going to be my next step. (0+ / 0-)

      Send my files to the Philadelphia Inquirer.

      I'm also going to send letters to all my representatives as further evidence that we need reformed health care NOW.

      Enjoy it now, Sarah, 'cause we're kicking your silly winking folksy lipsticked ass back to Alaska. For good. Also.

      by Kaili Joy Gray on Fri Oct 24, 2008 at 11:37:22 AM PDT

      [ Parent ]

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