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.
Blue Shield dropped the ball
Regardless of your perception of insurance agents as callous out-for-the-buck sales people, when a client is suddenly without coverage because of bureaucratic ineptitude, any agent like me is going to lose sleep over the situation. What was the most frustrating was that we followed all the steps to enroll him in a new ACA health plan. In spite of our efforts, the new IT systems put in place by all the carriers thwarted a seamless transition from an existing health plan with the same carrier to a new ACA health plan.
ACA creates IT invoice problems
The short version is that my client had a guarantee issue HIPAA plan through Blue Shield. Instead of accepting Blue Shield’s roll over into their Ultimate Platinum Plan, the client decided to enroll in a Silver Plan. The new Silver plan would save him $250 per month with no ACA tax credits. Blue Shield ignored our application and enrolled him into Silver plan with a different ID number. They continued to invoice him under the old ID number with the new Silver plan premium amount. He faithfully made those payments, and because the amounts were correct for the New Silver plan we applied for we figured everything would work out in the end.
Cancelled for paying the premium on time
My first indication that there was a problem was when I received a letter he was being cancelled for lack of premium payment. Numerous calls to Blue Shield assured me that the billing system just had not caught up to the payments. But he was cancelled nonetheless. The excuse from Blue Shield was that my client was making payments to the old billing system and they had no way to transfer the credits from the old to the new system.
Provider bills go unpaid
On April 1st Blue Shield said they would reinstate the health plan and generate a statement showing the clients payments. In addition, the customer service representative said the client actually underpaid and would have to make up the difference before the policy could become effective. While Blue Shield was trying to figure how to integrate their billing systems, my client is getting bills from office visits because Blue Shield was refusing to pay on a cancelled health plan.
Time for a sit-in at Blue Shield
Out of sheer desperation I figured I had to visit Blue Shield corporate because it was impossible to actually talk to an “IFP Specialist” on the phone even after a
two hour wait on hold. I certainly couldn’t ask my client to call as he was most often driving his big rig across America delivering goods and making a living. Fortunately, the nicest security receptionist in the lobby put me in contact with Bennie Johnson who an Operations Management Supervisor of Customer Service. After a few conferences, Bennie came back out and gave me my client’s new member ID, told me all his claims were being run through processing again and gave me the account balance.
Good people and dumb systems
With luck, Bennie solved what could have been a royal fiasco if my client was injured on the road. Of course, the proverbial proof will be in the pudding. I’m used to hearing a promise from a health insurance company only to have that action evaporate like water in Death Valley. The ACA transition has served up some unappealing consequences for existing and new members with billing hassles. The good news is that they can be fixed, but sometimes it takes a trip to the kitchen to have the chef cook it properly.