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."

Random DMV Ridiculosity

Tangent time! This is not about health insurance but its sinister-and-evil cousin, the DMV.

I got married + I am a woman = I am trying to change my last name. The DMV decided that it did not like this idea. Apparently, you need a driver's license with your name on it if you are to be taken seriously these days.

On October 19th, 2010, I went to the DMV with my new social security card and my marriage license, and successfully applied for a new driver's license with my married name on it. They issued me a temporary license, punched a big hole in my current license to invalidate it, and forced me to carry around my passport in the hopes of garnering booze without fuss.

On January 5th, 2011 (I still had no new license), I went on an out-of-state job interview. The company with which I was interviewing had reserved a rental car for me to drive around. Unfortunately, and unbeknownst to me, my temporary license had expired on December 17th, 2010. Taxi it is, then!

I went to the DMV a few days later to renew my temporary license, and they informed me that my license had been mailed on December 23rd, 2010 (mind you, this is a week after my temporary one expired). It was now January 7th, two weeks after they had "mailed" it. They told me to be patient.

:-/

Anyway, today is January 28th, 2011, and more than a month has passed since the "mailing" date and the DMV repetitively telling me to be patient. [Sidenote: It is nearly impossible to get a customer service representative from the DMV on the phone from their crazy phone tree madhouse. Their selections on the phone tree are vocally based, so if you just mumble nonsense into the phone at least 3-4 times, the automated system gets frustrated and sends you to a live person. Bingo!] I called the DMV, and after being on hold for more than 30 minutes they informed me that my license had been returned by the post office, so I had to call some other weird department in Sacramento where it was being held. After calling multiple times and hearing their busy signal, I finally got through and was told that I needed to be certified to receive confidential mail.

???

The DMV dude told me I needed to contact the postmaster (WTF?) to sort this out, or make sure my name was on my lease agreement. My name is on my lease agreement...with my maiden name. Apparently because my new license with my new name does not match my maiden name on my lease agreement, the USPS (in cahoots with the DMV, for sure), decided to hold my license hostage. What makes this so much better is that I tried changing my name on my lease agreement but was told that they needed to see my new driver's license to change it.

Just to sum up...I need my new driver's license to change my name on my lease, which I can't change until I get my license. Sweet. How does this not happen to more people? Don't other people get married and change their names ever? No? Anybody?!?!

This is my plan of attack: 1) I have called the post office trying to figure out how the hell to contact this supposed postmaster. They have informed me they will call me back on Monday (today is Friday). 2) Take my new social security card, my old driver's license, my passport, my marriage certificate, and some crisp Benjamins to the lease office at my apartment complex in an effort to make them change my name to MY NAME. We'll see what happens. I'm going to eat a strawberry cupcake right now.

One Sad Puppy

A trip to the pathology lab is my favorite thing ever...and then I woke up.

Amidst the hubbub of unpaid claims and antagonistic rejections on the part of Blue Shield, I thought that this little claim from the pathology lab had merely slipped through the cracks (as aforementioned in the previous post). I had been sent to Westcliff Labs by my specialist to get some samples taken. Apparently, and this is no joke: IT IS THE RESPONSIBILITY OF THE PATIENT TO KNOW WHICH PATHOLOGY LABS THEIR INSURANCE COVERS, NOT THE DOCTORS/OFFICES THAT DEAL WITH THESE SITUATIONS ON A DAILY BASIS. Lovely.

So, if you couldn't gather by by rude capitalizitude, Westcliff was not covered by United Healthcare (since I didn't have their stupid referral) nor was it covered by Blue Shield. So why did the doctor send me here AFTER asking me what insurance I had? Because not sending me here would have made sense.

Luckily, the bill was small, but I ultimately lost this battle (and $90) since there was no way to dispute it other than to say I was really sad, like the puppy in this picture. That didn't work.

PS - Just to add to the fun, the pathology lab messed up my results because they stored my samples improperly and were unable to analyze them. They told the doctor this, but not me. The doctor never called me either. After waiting for a few weeks and becoming impatient to hear my results, I called up the doctor's office and they informed me that I had to go back to the pathology lab again (were they ever going to tell me this??). Luckily, this one was on the house!

Big Blue Monster

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...

New Blue Horizon

I had just signed up with Blue Shield of California, and was still very much sick. Excited to be on an actual PPO, I quickly located a specialist that suited my needs and made an appointment. I was excited to meet with a specialist after being told by the ill-informed general practitioner that I did not need one, even though they could not figure out what my problems were or fix them. This was a problem with my United Healthcare graduate student "PPO" since I needed a referral to see a specialist...or even my general practitioner.

Anyway, I waited a month for the new Blue Shield to kick in, and then I went to see my specialist. She was great, and immediately suggested that I have a minor procedure performed in order to investigate my illness. I was scheduled within a week, had the procedure, and scheduled a follow-up appointment. Before going to the next appointment, I had to go to a pathology lab and have more samples taken for analysis. I went to said appointment, viewed results, and received a new prescription medication.

Summary of potential health insurance problems: 2 doctor's visits, one procedure (which involved being put under, a biopsy and brief hospital tenure), and a visit to the pathology lab

About a month and a half into all of this, I was blissfully imagining that Blue Shield was magically taking care of everything. You know....paying the bills, letting me have peace of mind...all that jazz. I was wrong. VERY WRONG.

So apparently, Blue Shield had decided to deny all of my claims on the basis on my having a "pre-existing condition" which exempted them from covering all of my bills. Well, I did, but according to California law, this doesn't matter as long as you were continuously covered under another insurance provider for at least six months prior to switching insurance providers. I had obviously been "covered" continuously by United Healthcare.

Back to customer service....my favorite. I explained that I had been covered, and they said that I had to get a letter from United Healthcare proving that I had been covered by them for at least the past six months, and send it to their provided fax number. I want to note that this is ALL they told me (this will be important later).

United Healthcare customer service.... I explain that I need a letter proving that I was covered for the past six months blah blah blah and the minion seems to understand. I ask her to fax it to me, and she does. When I receive the fax, I discover that she sent a letter expressing that I had been covered for the past 3 months only. >:-O Ok....I call again and explain the situation very carefully. The minion explains that because I am a student and the health insurance is provided on a quarterly basis, that the letter can only reflect a 3 month period. I try explaining that I need 6 months proof, and they are required to grant this to me by law. Minion thinks quickly, and decides that they can send me two letters, one showing coverage of the most recent 3 month period and another reflecting the previous 3 month period. This seemed inefficient, but I went with it.

Both letters in hand, along with my fax cover sheet, I send it all to the fax number that Blue Shield sent me. Thinking all was well, I went on my merry way.

Two weeks later, I notice that none of my claims have been processed by Blue Shield. I call them again, and ask about the verification letter from United Healthcare. They tell me they had never received such a letter. >:-O Ok....I ask how I can get the letter to them as I had already sent it to their fax number and that apparently doesn't work. "Did you put your provider number on the fax?" minion asks pointedly. "No," I say, "Nobody told me to do that. Why would I know to do that?" After further discussion, minion also informs me that I was given the wrong fax number. >:-O Ok, I send the fax again, using my newly garnered information...

I will spare you the details of what transpired, but I will tell you that it took me 4 more phone calls, 5 more faxes to 5 different numbers, people, and departments, and 4 more weeks before they actually acknowledged that I had sent the letter to them. They processed the letter, and eventually re-processed the claims.

Did they pay the bills this time, you ask? NO. While they were no longer denying them under the previously existing condition caveat, they had discovered a new and more annoying way to deny my claims. Stay tuned for more fun times...