So why is this significant? Because Kaiser was sending statements to the Covered California household for past due balances greater than one month. They were also sending termination notices even though they had already sent Covered California cancellation of the plan and Covered California terminated the enrollment. But Covered California will not investigate the erroneous terminations. They just tell the agents and consumers they have to deal with the health plan. In this case, the family has sent voluminous amounts of documents to Kaiser showing they made their premium payments.
The narrow doctor networks of California’s individual and family health insurance plans are actually smaller than first thought as doctors use a bait and switch tactic to lure in patients and then bill for their services with “out-of-network” providers. The health insurance companies have little control over this practice that has a doctor listed as in-network for their health plan, but the services are actually billed by a facility that is out-of-network. This bait and switch tactic, aided and abetted by confusing online provider search tools and opaque billing statements and codes, leaves consumers paying more for health care services than they should.
Blue Shield of California’s billing system that created major headaches for individuals and families in 2014 continues to stumble into 2016. Even through changes to the enrollment website, the simple tasks of determining an applicant’s eligibility and properly applying a premium still seems elusive to Blue Shield in several instances. For whatever reasons, several of the Blue Shield units – underwriting, eligibility, billing, member services, and IT- don’t seem to talk to one another.
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 […]
Another glitch in the Covered California enrollment system has been uncovered. When a household moves to a new address and the new residence is in a different rating region, the individual or family may receive an additional bill for back premium amounts. The software quirk that allows the health insurance carrier to invoice for past […]
Six months into the new ACA health plan year and Blue Shield of California still has a broken billing system. Individuals and families who bought their 2014 health plans directly from Blue Shield and then had a change in the household members being covered are encountering issues with their invoices. Blue Shield has been unable […]
To be honest, I was fully prepared to be dragged kicking and screaming out of the Blue Shield of California corporate offices in El Dorado Hills. Numerous phone calls and emails on behalf of a client who had made his monthly premiums like clockwork, only to have his health insurance cancel, resulted in hollow promises and no action by Blue Shield to resolve the billing and cancellation nightmare. My last hope to help restore the health insurance for my long distance truck driving client was to rattle the corporate cage of the carrier.
At a hastily arranged conference call for insurance agents to address a variety of issues involving new individual and family health plans for California, the Anthem Blue Cross Regional Sales Manager for Northern California announced they were extending the payment deadline until January 31st for policies sold through Covered California with effective dates of January 1st, 2014. This is the third time Anthem has extended the deadline for new enrollments.
The Centers for Medicare and Medicaid released the cost they pay for the top 100 hospital treatments for beneficiaries of Medicare across the country and the data presentation is virtually worthless to the average human being. The Charge master data set was successful in highlighting the complex and dysfunctional system we have in the U.S. for tracking and paying for health care.
In the case of the malnutrition reported at hospitals in Redding and Victorville, Prime Healthcare Services was billing Medicare for treatment of kwashiorkor disease which is a form of malnutrition found in countries racked by famine and civil war.