It’s a shitty day for a lot of people here at BMT, so I’m going to change the subject from the despair for just a minute, because over the past two days, I fought Blue Cross and WON. But first, a little backstory [Waves fingers, makes time travel sound.]
Soon after I signed up for healthcare through the federal exchange, my income abruptly changed in a downward direction, so I did the responsible thing and reported the change to healthcare.gov. Because I was now poor, my premium dropped from $188 to about $27. While adjusting my numbers, the ACA website froze up (as it often did back in those heady days). The representative on the phone told me it would only take a day or two to fix the technical difficulty, so moving forward, I should ignore the $188 premium Blue Cross expected, and pay the $27 instead.
I never heard back from the government about whether the problem was solved, but after a few more $188 invoices -and a steadily growing back balance of $350 and counting- I called back. This time the healthcare.gov rep told me:
A) the first customer rep misled me, mistakenly saying the problem would be fixed in a day or so;
B) the reality was that it would take a few months to sort out; and
C) even though it was not my fault, I now owed Blue Cross $350.
I do not make a lot of money. After taxes, I make $400/week. The rep was very contrite and sorry, apologizing for and acknowledging the miscommunication, but told me to take it up with Blue Cross.
So I did. But what I found out was that Blue Cross doesn’t payment plans. They wanted their money in one lump sum. But I could not do that. Not when I make $400 a week and have to pay a mortgage, child support, student loans, etc.
So, ever since I have been paying my $27.00 premium plus $25 extra to chip away at that back balance. I have been doing this for the past 3-4 months, every time I get a bill in the mail. I have never received a cancellation notice. My asthma prescription continues to be covered. And my bill always shows me that $27 went to my premium, while the remainder was applied to a steadily shrinking balance.
So there’s your backstory. Now, imagine my surprise this past Sunday when I opened a letter from Blue Cross stating that they would not pay for $1100 in lab services undertaken at my annual checkup, because I wasn’t covered at the time. Funny: they take my premium. They apply my extra payment to my back balance. They cover my asthma medicine. But all of a sudden, “I’m not covered”?
I’d like to veer off on a [related] tangent for a second. One of the most infuriating things about Blue Cross is their shitty, two-tiered customer service. See, if you call their toll-free number, you can expect to sit on hold until you die of old age. But if you have a computer -unlike many African American, Latino, and immigrant families- you can reach them on Twitter, where they are very responsive.
So Monday morning, I twitter-twatted at them, and got a callback that afternoon… in which some poor woman got the thankless task of telling me that because I hadn’t paid them their $350, I wasn’t covered. Even though, ya know, they’d never actually canceled me, continued to cover my medicine, and (most importantly) continued to take my money.
I can be a bit of a hothead (I know, big surprise) and although I try to rein it in, I fucking EXPLODED. I honestly can’t blame the woman for hanging up on me. And then I took to Twitter, with a very basic message for Blue Cross:
I started with “@IBX i have had enough of this BS. I’m just going to talk to some reporters about what you did.”
And then I began tweeting at my reporter friends, making sure to include Blue Cross: “@KYWNewsradio pitch: @obamacare screws up subsidy, @IBX screws Philadelphia single dad for covered services. Great story, tawdry.” And so on. I got a response from a fellow at Philadelphia Magazine, who was interested in my pitch (he cc-ed Blue Cross too).
By this point, I needed to get the seething rage out of my system, and headed out for a 5 mile run. Around 7:30 PM, while enjoying my post-run beverage, my phone rang. The area code was from Delaware.
“Hello?” I said.
“Hi, this is Scott McSomeone, Vice President of Customer Service for Blue Cross. Is this Brendan Skwire?”
“It is. What do YOU want?” I replied, dismissively.
“Well, um… I’d just like to discuss the issue you’re having.”
I stood there, silently, for a good ten seconds, which is an eternity on the phone.
“Hello? Mr. Skw–?”
“I don’t know if I want to talk to you.” Long pause.
“Well, umm…”
Interrupting him, I added, “I think I want to talk to the reporter who called me earlier today. There’s kind of a line in front of you that wants to talk to me first.”
Another long pause. And then, “Well, we’d really like to see if we can work something out.”
“I’m also really upset,” I said. “So if I decide I want to talk to you, maybe I’ll call you tomorrow morning, maybe?”
“Sure, that would be great,” Mr. VP said. “I hope we’ll be able to work something out.” And so we ended our conversation, while I did a little Snoopy Dance because I realized things might be going my way. Blue Cross wouldn’t have called me back if they thought this was something they could ignore.
Tuesday morning around 9:00 AM, I gave the VP a call back, at which point I related -for probably the fourth time- what had been going on since summer. After listening to the whole sorry story, Mr. VP said he had to meet with his team to see if there was anything they could do and that they’d be in touch later in the day.
The call arrived during lunch. Blue Cross, the VP told me, was going to make me whole. Not only was I not on the hook for the $1100 in lab tests, they decided to wipe out the outstanding debt. “It wasn’t your fault,” the VP told me, “and this never should have happened.”
I thanked him profusely -I may be upset with Blue Cross but I’m not stupid- and then took the opportunity to advocate on behalf of other people.
“I don’t know if you know this but, deliberately or not, Blue Cross has two tiers of customer service,” I began and launched into how long I would stay on hold on the phone, versus the quick response on Twitter. “This is a blatant health inequity,” I said. “People who don’t own computers -like a LOT of African American families, elderly people, and people who don’t speak English well- are at a major disadvantage when something goes wrong with their insurance. Your department should really do something about that. A happy customer, after all, is a loyal customer.”
The guy agreed and said that Blue Cross hadn’t anticipated the sheer number of new customers they were going to get from the ACA. He also said that they were discussing setting up payment plans for customers with in circumstances like mine.
So score one for the little guy. A little moment of sunshine on an otherwise dark and depressing day.
Just wanted to give y’all a little hope is all. Sometimes when you fight, you win.
great news
The guy agreed and said that Blue Cross hadn’t anticipated the sheer number of new customers they were going to get from the ACA.
I hope he was just putting you on with that line. Either way, it speaks of what shitty business people they are.
<3
<3
“Sometimes when you fight, you win.” Like getting the Patient Protection and Affordable Care Act passed in the first place. Yeah, yeah, it could (and should!) be a lot better. But for folks who were out there completely unprotected, it is a huge win.
This, that you were able to get coverage, so that you had something to fight BCBS for, This is what we fought for in 2008. We fought to keep it in 2010 (not enough of us) and 2012, and again yesterday. Now we just need to fight harder, to get more of us to realize how important non-Presidential years are.
Good for you! That’s a rare win. And yes it’s sad you had to go to social media to get action.
For the next two years, it’s exceedingly likely that Congress will propose budgets that completely defund the ACA. And that they’ll shut down the government over it. When they do, the numerous people who’ve had insurance company problems but weren’t connected and savvy enough to get a callback from a VP are going to think the Republicans are fighting for them, unless we tell a different story.
God knows, most Democratic candidates aren’t telling that story. Media, either.
I’ve never had a problem calling Blue Cross and I don’t have a twitter account nor facebook. I’ve never contacted them over the internet. I’m not a minority, but I do have a Spanish surname. Never seemed to make a difference.
Because I have FEHB not Obamacare, maybe the number is not the same. The number on my card is 1-800-972-8382
Not only have I not had any trouble calling in, they have gone to bat for me (OK and them) on spurious charges from healthcare providers and preferred providers trying to get more than the BCBS agreed charge from me. My premium (total charge for me and the government together) is $1392.30 per month. Yes, that’s four digits before the decimal, not three. Maybe that’s why the difference in service.
The “mistakes” that happen in the healthcare and health insurance industry that always wind up moving money in the direction of the providers and insurers is astounding. And the DHHS CMS callcenter staff never advocate for the patient; always explain how somehow we misunderstood.
Led me earlier to advocate that Democrats campaign on eliminating deductibles, co-pays, and balance billing. None listened. Oh well.
Congratulations on the ability to build a box that gets justice. These sorts of individualized solutions are not easily reduplicable. You might have future as a patient advocate to level the playing field between patients and large institutions.
” eliminating deductibles, co-pays, and balance billing”
Don’t know what balance billing is but I’m with you on deductibles and co-pays.
Years ago they said that deductibles were to keep small claims from eating up resources. Well $600 is not small and $12000 on a Bronze policy is only small to Jamie Dimon. Besides, unlike car insurance the deductible is not applied to every claim so once I meet it, my $4 prescription (less 97 cents copay) gets processed. Not really much cost either as my pharmacist types it into the computer and the internet and BCBS computers handle it from there. Sure the setup cost was huge but the running cost per claim is miniscule.
Copays are to have “skin in the game” and prevent frivolous claims. All they do is keep the desperately poor from care and annoy the more affluent. Today my wife saw our primary care physician for preoperative approval. The copay was $20. We spent $16.14 for lunch (senior citizen special). It was just an annoyance to us (take out the card, take out the ID, sign a bunch of privacy forms). For someone else that $20 might mean waiting a week or two or even forgetting about the surgery (God knows what the copay will be for that, probably hundreds).
Years ago BCBS put in a system whereby you had to get clearance from a BCBS nurse for hospital admittance or they wouldn’t pay. Some undoubtedly Republican manager got the idea that people check into the hospital for free food and a bed. Five years later they dropped it and saved the cost of the nurse and phone. They admitted to my company that they had never refused admittance. Not once. I would think not. What if their nurse overrode a licensed physician’s decision and the patient died as a result? L-A-W-S-U-I-T These managers think people order their doctors to admit them. Maybe they (corporate managers) do. The rest of us sure don’t.