My sister will be having a baby soon. As a result, I need to get a common shot (tetanus) if I am going to be able to visit her after the birth. Simple, right? I don't have cancer, thank God. I don't need major elective surgery. I was not hit by a bus. I just need a simple shot that medical professionals in other countries -- both rich and poor -- administer for free, or for a few bucks if you're really unlucky.
Enter CareFirst, the "non-profit" -- meaning "profits" reclassified as something other than "profits" are just spent on absurd CEO salaries and administration -- Blue Cross and Blue Shield insurer for our nation's capital. I have my Obamacare HMO plan with $4,000 deductible (solid bronze!) through this glorious insurer with a very luxurious office building, I might add, behind Washington's Union Station.
Follow me below the fold to witness the insanity of American health care. And, remember, this is just for a tetanus shot. Nothing more than that -- a simple, little tetanus shot.
Last week, I sent the following email to their "secure messaging service" while logged into my account:
Since I am so blessed to have an HMO plan with a $4,000 deductible -- what do I need to do if I would like to get an updated TDAP shot so that I can be around a newborn child? Do I need to see a primary care doctor first? Or can I go to a CVS/Walgreens and get the shot?
The automatic response:
Dear Xxx Xxx: Thank you for your email dated 06/01/2014. CareFirst Blue Cross Blue Shield works to resolve all inquiries timely. Once your inquiry has been resolved, you will receive an email giving you an update or a resolution. We appreciate your patience during the review process. Sincerely, Customer Service Department
After a few days, I never received a response to my simple question, so I went to Twitter simply requesting a response to my email. I stated that I did not want to receive a phone call to discuss the matter, because my plan only includes 100 minutes/month. And, guess what? At CareFirst, if you want to pay your premium bill, they have a special super-awesome number where you wait only 30 SECONDS to speak to a human being straight away, but if you actually need to see a doctor, well, from my experience, you have to wait on hold for at least 30 MINUTES -- or let them pick a time to call you back. (Not so great if you care about looking responsible at work.) Did I tell you they only have customer service available from 9 AM to 5 PM?!
So, they, miracle of miracles, decided to send me an email:
Hello Mr. Xxx,
Thank you for your most recent Social Media inquiry. Unfortunately, our team did not receive your email but we would be happy to assist you with your benefits questions. Please respond to this email with your questions and we will respond back. Please allow 24-48 hrs. for a response.
If you have any additional questions, please call one of our Customer Service Representatives at the telephone number listed on the back of your member ID card. If you are not able to get through on the customer service phone line, please feel free to contact customer service via Contact US under MY ACCOUNT, Facebook, Twitter or this email address. Please allow 24-48 hrs. for a response.
Sincerely,
Xxx
Social Media Response Team
Of course, they didn't receive my "secure" email. So, I respond:
Xxx,
Thanks for your email. If the secure email feature on your Web site does not work, why does it exist? Should I not plan on using that feature of the Web site in the future? That is my first set of questions..
My original questions (sent at 3:21 PM on June 1, 2014 via your Web site -- and I received a response on June 1st that said that it would be answered within 48 hours):
What do I need to do if I would like to get an updated TDAP shot so that I can be around a newborn child?
Do I need to see a primary care doctor first? Or can I go to a CVS/Walgreens and get the shot?
Also, will this be treated as free preventative care as it is a vaccine? Or will I need to pay towards the deductible?
Cheers,
Xxx
Simple questions generally command simple answers, but not when you're dealing with CareFirst -- or any private health insurer in America:
Ok, Mr. Xxx,
Yes our secure email from the www.carefirst.com website does work as far as I know but the Social Media team would not see it as we have our own communications setup through the social media pages on Facebook and Twitter.
To answer your benefits question: your plan does provide benefits for preventative immunizations for adults which includes the Combined Tetanus, Diphtheria and Pertussis (Tdap) Vaccines. You would need to get it administered by your primary care physician or an In-network specialist in an office setting. Your provider network is the BlueChoice HMO. The benefits is: covered at 100% of the allowance, it does not apply to your calendar year deductible and ALL claims are subject to medical review so quoting a benefits does not guarantee payment of a claim.
Let us know if you need any other assistance if you cannot reach our customer service team via telephone or our correspondence team via email.
Have a great day!
Xxx
Social Media Response Team
Really, your email system works? Well, it's been over a week, and no response yet. So, I seek to clarify:
Thank you, Xxx.
In the future, should I assume that the secure email service on your Web site (when logged into my profile) does not work?
Again, they respond with a non-answer answer:
I would not presume to advise you of that, we have not been notified that is doesn’t work at this time. But you now have this teams email. Feel free to utilize it. Thanks, Xxx
But, well, I take them up on their offer and ask a slightly different question, because I had called my "Primary Care Provider" -- actually, a very low-ranked "urgent care" center that somehow qualifies as high-quality primary care -- and the receptionist was unable to tell me if I would be billed or not for the shot -- but she did tell me I would have to pay, for sure, $125 for a "new patient visit" in order to have the shot administered. So, my question:
Xxx,
I was told that if I was to get this vaccine in an office setting, it would be covered, but I would need to attend a "new patient visit" first and have it prescribed. Would I have to pay for this "new patient visit"?
Thanks,
Xxx
P.S. The secure email service on your Web site most definitely does not work.
Now,
their response to this question is truly awesome:
Hi Mr. Xxx,
You have the benefit for routine preventative immunizations in an office setting, the provider may bill for the office visit and the vaccine.
If the provider is your PCP, in the office, there are 2 possible benefits:
1. Medical office visit – subject to the $4000 benefit period deductible then considered at 100% of allowance after a $30 copay OR
2. Routine Adult Physical in the office– which is considered at 100% of allowance (no deductible or copay)
But it all depends on how the provider is billing it, claims are subject to not only medical review but are processed based on the diagnosis and procedure codes we receive against your contracted benefits.
If the provider is a Specialist, in the office, there are also 2 possible benefits:
3. Medical office visit - subject to the $4000 benefit period deductible then considered at 100% of allowance after a $40 copay OR
4. Routine Adult Physical in the office – which is considered at 100% of allowance (no deductible or copay)
5. OUT OF NETWORK IS NOT COVERED under this BlueChoice Bronze plan
To date, we have not received any claims to apply towards your deductible – you have met ZERO towards your $4000 Calendar year benefit period.
I apologize that the secure mail is not working for you, we have checked with our Tech support team and there are no known issues. If you continue to have trouble, please contact the Tech Support team directly at 1-877-526-8390, they are available Monday to Friday, from 7 a.m. to 6 p.m. We appreciate you letting us know there is an issue.
Thank you,
Xxx
Social Media Response Team
Wow -- just w.o.w. -- wow! If anything CareFirst has just complicated my simple query by 1,000,000 percent -- and I still don't have my answer. I try again:
Hi Xxx,
Wow -- that's a lot of information. Let me try again:
I have not visited the PCP at all yet. If I visit the PCP for a "physical" -- and request to have this vaccine -- will I be charged anything towards this deductible or will I not be charged anything towards this deductible. In other words, will I have to pay anything out-of-pocket?
That is the information that I am looking for -- sorry you had to type so much.
Best,
Xxx
And, of course, another non-answer answer:
Hi Mr. Xxx,
Let me try to simply. [sic]
If the “physical” is billed as routine then no deductible or copay but we would not know how the doctors will bill it, you may want to ask them because if it is billed any other way then it would hit your deductible since it has not been meet. [sic]
Is that a little better?
Xxx
A non-answer answer with sarcasm! Score.
But, now I remember that the doctor's office receptionist had said I could see any doctor in their practice and it would be "covered" by my health insurance, but CareFirst had told me earlier -- in this massive Kafka-esque nightmare chain of emails -- that it would only be covered "if the provider is your PCP, in the office..." So, again, I seek additional clarification -- and also express sympathy for the poor person tasked with answering my questions:
Ok, it's a little bit better, but still quite maddening, as I would like to be certain as to what I will or will not be charged prior to electing to visit the doctor.
Earlier, you said the following: "if the provider is your PCP, in the office, "
The doctor's office said that I can visit any doctor in their practice and it would still be covered, even if it is not the doctor whose specific name is explicitly listed on my card. Is this true? Or must I visit the exact doctor on my card? If so, that could be quite difficult, as the only primary care practice accepting new patients in my part of DC is this "urgent care"-style facility.
I don't envy your job attempting to simplify America's insane health care system for patients.
Well, it's 6:16 PM now and I don't think I'll get an answer before the weekend, which is kind of problematic, given that I don't have sick days (remember, they're not required by law in America as in all other rich countries) and I was planning to try and visit this doctor -- errr, urgent care center -- tomorrow.
Some might read this chain of emails and think, "What a jerk!" I, however, am simply trying to make sure that this nightmare of questioning does not become a nightmare of claims and billing problems after the fact.
How much time -- and money -- has already been wasted by doctor's office receptionists and insurance company bureaucrats attempting to answer my simple question? "How much, if anything, will this shot cost?"
This everyday nightmare -- for an everyday, incredibly simple medical issue -- is exactly why a single-payer system -- or, failing that, an all-payer system with government-mandated prices for all treatments and drugs -- is the only way we can resolve America's health care crisis.
Sat Jun 07, 2014 at 12:45 PM PT: To respond to some comments: yes, I was a tiny bit sarcastic in my first email -- shoot me if you want, but it takes a bit of humor to deal with the insanity of American health care. And, no, I did not write this diary seeking sympathy or in an attempt to assign outsized rage to, as I noted, the relatively simple problem of a tetanus shot. That's the whole point of this diary: getting a straight answer on a simple need in the American health care system is so profoundly complex that, well, it's hilarious, it's insane, it's silly, it's crazy -- and it can lead to epic e-mail chains like the one that I've shared -- and still has yet to be entirely resolved. To restate, my problem here is most certainly not a "big deal" and that's exactly why when Americans do face "big deal" health care issues (I have had two of these issues before involving surgery), the bureaucracy is absolutely crushing. Thank you.