Adding Insult to Injury

Whitesnake

It is October 2010, and I receive a fun packet in the mail from Blue Shield. It contains FIVE letters politely explaining that they wrongly paid five different claims because United Healthcare was my primary care giver during the dates of service, and that they would like the health care provider to pay them their refund within 30 days. Um...WHAT?!?!

Blue Shield: "We would appreciate your refund of $XXX within 30 working days of your receipt of this letter." I bet they would.

You may remember from one of my previous posts that what this means is I had to send my claims to United Healthcare, wait for them to deny the claims, and then send that to Blue Shield. You may remember it, because I already did it...and then Blue Shield paid the claims.

I investigated it, and it turns out that I only had paperwork documenting that at least one of those five claims had been denied by United Healthcare already. I checked my Blue Shield account, and that same claim had never even been sent to Blue Shield, or documented in my account. Basically, I had no way to even know that this claim had occurred, or that Blue Shield had ever paid it, even if "accidentally". Unfortunately, since it has been about six months since I have last heard anything of this debacle, I had nothing to prove that I had already fought this battle.

However, according to the wording in the letters, the health care providers were told to send their claims to my primary insurance provider (United Healthcare), and then send the explanation of benefits to Blue Shield with any remaining balance. In theory, I was not to be involved if the health care providers did everything properly....unfortunately theory and logic are not familiar to the health care system, as I will divulge to you in my next post...

So, in the famous words of Whitesnake, "Here I go again...on my own."