Blue Shield’s bumbling billing system bounces into 2015 -

Blue Shield’s billing seems broken beyond repair.

In 2014 the combination of Covered California’s enrollment issues and Blue Shield’s bumbling billing system created massive headaches for Blue Shield’s members and their staff. With the dawn of 2015 we have witnessed that Blue Shield of California still hasn’t resolved many billing issues for individuals and families attempting to enroll in their health and dental plans. The time wasted by me and my clients trying to fix stupid billing problems gives me pause when asked if I can recommend Blue Shield of California health plans.

Health insurance is complicated

The operation of a health insurance business is complicated. Aside from actually receiving and paying member’s claims for health care services, every health insurance company must have several other systems just to support marketing and enrollment. Among those departments are an information technology division for the online quotes and applications, an eligibility department to scrub the application, customer service representatives, enrollment department to put the new members into the system, and a billing department to collect member premiums.

All carriers experienced billing issues in 2014

Even after years of working with Covered California and preparing for the dawn of the ACA open enrollment, many carriers experienced massive failures with their enrollment and billing systems. Happily, most of the carriers have seemingly worked out the kinks and are operating in relatively smooth fashion. Unfortunately, Blue Shield is still experience long delays for processing the simplest of tasks such as enrolling in a dental plan. (Don’t confuse Blue Shield of California with Anthem Blue Cross of California. They are two totally separate companies in California.)

Many Blue Shield enrollments have no problems

To be fair, most Blue Shield enrollments, either on or off the exchange, travel through their systems without a hiccup. But for a small percentage, the smallest irregularity in the application or payment can create delays in enrollment. The worst part is that Blue Shield seems to be causing most of their own headaches from systems that don’t seem to be properly integrated. Blue Shield even admitted to me that in 2014 they were having problems integrating the old billing system with the new billing software.

Blue Shield’s bumbling billing bites members

Here is a typical example of the bumbling Blue Shield systems. I have client who used Blue Shield’s website based quoting and application tool to apply and pay for their first month’s premium for health and dental insurance. The website was pretty cool because it allowed for a split quote: one family member enrolled in a Platinum plan while the other family member selected a Silver Plan. Plus, they were able to add dental to the overall health insurance package. All of the health and dental first month’s premiums were easily paid online with a credit card – ecommerce at its easiest. But that’s where the good news ends.

Systems don’t talk to one another

The online application creates, at least from what I can see, PDF files that must be entered into the system by hand for eligibility. The billing information is sent into another system. For my client, all the money for the health and dental plans was attributed to one person showing the spouse as not having paid for either health or dental. It took two phone calls to get Blue Shield to recognize their simple bookkeeping error of not properly distributing the funds to each person’s health and dental plans.

Intractable incompetence

While we finally got the health payments properly credited, Blue Shield refused to acknowledge the dental enrollments. I had to direct the customer service staff on several occasions to review the PDF application indicating that both individuals in the household had enrolled in dental. Thirty days after my initial telephone inquiry, Blue Shield has yet to fully activate the dental plans.

Each call reinvents the wheel where I have to describe the circumstances.
On each call I’m told the members don’t have dental, but then the customer service representative finds the dental in the family’s application.
On each call I’m told how someone made an error keying in the data.
On each call I’m told the last person I talked to never initiated any action.
On each call I’m told they are escalating the issue to eligibility, enrollment and billing.
On each call I’m told how they are swamped with re-instating policies cancelled by Covered California.
On each call I’m told it will take seven to ten days to resolve the issue.

Billing issues that lead to cancellation

I’ve just never encountered so many billing issues and incompetence with one company before. And this isn’t my first time mud wrestling with Blue Shield. Other prominent billing issues have been

Attributing premium payments to a member’s closed account instead of his new 2014 enrollment triggering cancellation.
Repeatedly denying receipt of a family’s enrollments from Covered California.
Cancelling a family’s health plan after they had a new baby.
Attempting to collect premiums for a member in one region while the individual had been living in a lower premium rate area of California.

These were all stupid billing problems, errors and mistakes. There was no nefarious attempt to deny health insurance or commit fraud. This was, and continues to be, the result of a crappy billing system or systems.

Blue Shield, hire someone to fix your billing mess

Blue Shield touts that they are a not-for-profit company who states they limit their net income to 2% of revenue. I’d like to see them take that 2% retention and hire some people who can fix their billing and enrollment systems. Or at the very least get their different systems to talk to one another. My clients just want what they have dutifully been making their monthly premiums for – health and dental insurance without the run around.

Menu