We're From Blue Cross and We're Here to Help

As the end of the year comes upon us, many folks try and get that last prescription refill before the new plan year starts and their deductible resets.  I added my kids for this coming year so I was one that was trying to get one more refill before the higher deductible took over.

I am acutely aware of the crush of business at year end and I know better than to wait until the last minute to refill so I called on December 22 – plenty of time to avoid the year end rush.

Except…

When I went to refill my prescriptions, my copay, which should have been about $30 was going to be closer to $200!  I cancelled the refills and then called “customer service” to find out what was going on.

For reasons I don’t understand, Blue Cross/Blue Shield of Illinois decided that it would behoove them to add my kids several weeks early. My guess is that they were either trying to get a jump on year end paperwork, betting that there wouldn’t be another claim or someone screwed up data entry.  I think I’d be on the former rather than the latter.

My deductible, which HAD been met, now was not. To their credit, BC/BS did admit that it was their error (well ONE person of the half dozen spoke with did...) but, of course, it would take 3-4 business days to take care of (I’m SURE that it is the most difficult thing in the world to reset that – I’m sure it takes a damn army).

Being a good patient I waited.  My mom, aunts and now my fiancée are all/were all involved in health care so I know what to do to be a good patient.  I don’t blast the people I talk to on the phone because I know the repercussions to the people on the other end.  They’re just trying to do their job and most really just want to help if they can.  I made one follow up call a few days later before Christmas to let them know I’m still thinking of them.  It was still being worked on and it was still too early to have expected a resolution.

This week I started calling to follow up in earnest.

SUNDAY: Two of my medications have run out.  Allegedly this should be resolved in a day or two so while I’m not thrilled, a day or two won’t matter big picture.

MONDAY: It’s still being worked on.  With the holiday and all they’re really backed up but there is still time left to get this done.

TUESDAY: Still escalated.  Should be any time now, they’re working on it.

WEDNESDAY: I got wrapped up in racing work and missed my daily call.

THURSDAY (New Year’s Eve): Still being worked on.  If you pay cash we’ll reimburse you.  (eventually)

To nutshell all of this, BC/BS made a mistake.  They KNOW they made the mistake.  It’s allegedly a paperwork error in the age of computers and sophisticated patient management systems.  The “fact” (loosely interpreted) that it allegedly takes 3-4 days to fix is bullshit.  Nine calendar days later and my only conclusion is that you are doing all you can to screw me if you can. 

Here is my take – a complete interpretation on my part with no knowledge of what’s going on behind the scenes at the insurance company.  (Full disclosure: I worked for a health care company many years ago for 2-years, so I do have some idea of the mindset.)

I make the initial call and they realize they goofed.  Woman on the phone does the right thing by escalating it up through their “system”. Supervisor/Manager somewhere looks at it, sees they are short staffed for the holidays and sets it aside hoping to get to it later.

I call back to follow up and as I’m on hold, the ‘patient advocate’ (advocate my ass…) calls upstairs to see what’s up.  She gets bitched at that they are still working on it. So she passes along that it is still being worked on.

By Tuesday I suspect that the attitude around Blue Cross/Blue Shield of Illinois is that there is absolutely NO ONE “working on it”.  My guess is that no one wanted to take the time or effort to make the change  in “the system” and then have to take the 30-seconds necessary later to change it back again.  What they hell, I’m only a customer…supposedly.  I’m not.  I’m a number.  An individual profit center.  At this point, they feel they can just wait me out and the year will change and their hands will be tied.  Cha-ching, another couple of bucks made on member number XXXXXXXX.  Multiply this by several thousand (million?) across the country and that’s real money.  Pat yourself on the back folks, another jackass duped so you can add to the bottom line.

About an hour ago (New Year’s Eve) I get off the phone with a very pleasant woman who empathized with my plight (as I’m sure she was trained to do – but she at least sounded sincere) but, you guessed it, it was still being worked on.

However there was an alternative being now offered: pay about $200 in cash and we’ll reimburse you.  My translation of that conversation:

“WE NEVER HAD ANY INTENTION OF DEALING WITH THIS – AND WILL NOT – SO YOU BE INCONVENIENCED, TIE UP YOUR MONEY AND WE’LL GET AROUND TO YOU EVENTUALLY.”

Basically, go F yourself.

So NOW I have to get the refills reprocessed, wait in line at what will prove to be long lines at the pharmacy, unload a wad of cash and take hours out of my day that COULD have been spent doing just about anything else. 

I was prepared.  They were screw ups.  I am the one that pays for it.

Now since BC/BS had no intention of dealing with this, they should have just told me up front. 

“Sir, it’s the end of the year, we while made a mistake, we can’t fix it in time so you’ll have to pay cash and get reimbursed.”

Sure, I’d be irritated, but at least you would have been being relatively honest about the situation and I could have adjusted and got my meds rather than actually be dumb enough to believe you were working on it.

Furthermore, what if the additional $170 meant the difference between having heat in the winter or not?  Of buying groceries or not?  Middle and low income families are screwed in this scenario.  Living paycheck to paycheck, a $170 surprise at the end of the year – right after Christmas or Hanukkah have depleted the family account – can be the difference between medicine or not.  The casual nonchalance with which they just expect folks to fork out $200 indicates their complete lack of connection to the real world.

And if they can’t scrounge up the additional money in time to be eligible for eventual reimbursement they would get to hear something like this:

“Sorry, the new plan year has started and your deductible is now higher.  You’re not covered until another $1500/$3000/whatever has been paid out of pocket.”

What happens then?

Mom and/or dad go without their meds so the kids have food and heat. 

Whatev.

Happy New Year

[AUTHOR'S NOTE: I did manage to get my RX taken care of before the year end deadline but NO thanks to BC/BS.  My pharmacy took an inordinate amount of time out of their day - and their own year end crush - to be my advocate and make sure that I was taken care of in this plan year.  Additionally, BC/BS TOLD my pharmacy that everything was all set but failed to correct my co-pays until AFTER I went to pick up my RX and I learned it wasn't.  ONLY THEN was the co-pay backed up - when they were called on it.  Stay on these insurance companies - the more you pay, the more they make and it sure seems like they'll try anything to make sure they don't pay.]