Continuing from last time, I had about five claims that were being denied by my shiny new health insurance provider, Blue Shield. I had overcome one barrier (preexisting condition) only to be met by another... Imagine that by now it is approximately April 2010. My new prescription medicine has healed me! However, I am still dealing with the financial fallout...I was still enrolled in United Healthcare, in addition to being enrolled with Blue Shield. Because UH was provided by my employer (as opposed to being from my spouse), they were considered to be my primary insurance provider. Why is this a problem, you ask?
PROBLEM: Blue Shield slapped a footnote onto EVERY claim, stating that they didn't have to pay a dime because United Healthcare was primarily responsible.
So....back to the customer service minions. I explained the situation to Blue Shield, and even included my explanation of how United Healthcare won't cover it because I don't have a referral to the specialist because they wouldn't give me one. They explained how [they don't give a rat's ass] and that I have to send all the claims to United Healthcare first. I was told that if the claims are denied (and I simply interpreted this as "when" rather than "if"), then United Healthcare could send the claims to Blue Shield to pay any "remainder". This is commonly referred to as "cooperative benefits" when an individual is covered by two health insurance companies. One company processes the claim, denies or pays their share, then sends the leftovers to the other company to pay the remainder.
So....I called up United Healthcare and explained this to them, asking for their cooperative benefits department as I had been instructed to do by Blue Shield in order to set up this cohesion between my two insurance providers. I was quickly informed that United Healthcare did NOT have cooperative benefits (this figures), and that I would instead have to do the following in order to get Blue Shield to pay for my claims:
1) Call up every lab, hospital, and doctor's office and tell them to resend the claims to United Healthcare instead of Blue Shield.
2) Wait for United Healthcare to process and inevitably DENY all of the claims.
3) Take the denied claims, and send them to Blue Shield along with the original claim that was submitted to them in the first place.
4) Hope for the best.
Confused yet? Yes.
Frustrated? Yes.
Anyway, I follow step 1, and wait a month or two for United Healthcare to get around to denying everything. At least I can count on them to do that correctly. They did; step 2 complete!
Fearing what happened with the letter faxing debacle (see previous post), I decided I'd rather take my chances with the postal system. I wrapped up my carefully denied claims and mailed them away to Blue Shield, assuming they would arrive. Luckily, step 4 panned out quite well, and most of the claims were processed and many bills were paid!
In the meantime, I had learned that I could waive out of my employer health insurance (United Healthcare), and I did so promptly. I faxed the necessary paperwork to the Student Health Center, and didn't hear back. A brief call confirmed that they had excluded me from their terrible health plan. Yay!
I thought all was well, until I noticed that the claim to the pathology lab had not been paid. This got a little tricky, and is one battle that as of today, remains a loss for this poor graduate student. Stay tuned...
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