ladysprite (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
ladysprite) wrote2015-10-07 05:29 pm
ladysprite) wrote2015-10-07 05:29 pm
Where Is She Now?
So. I have gotten out of the habit of posting here regularly; shame on me.
My neck and shoulder are still a wreck. This would be because, ONCE AGAIN, our health insurance is also a wreck. This time apparently a glitch in the MassHealth Connector's computer system insists that, while our payments have been received, the money hasn't been sent to Blue Cross, so we can't be activated in their system. This is in spite of the fact that Blue Cross acknowledges that they got the payment from MassHealth - apparently both BCBS and MassHealth believe they have our money. But since the MassHealth system lists the payment as not having been passed on, I'm up the creek. And this is apparently a big enough glitch that it's taking them a long time to fix it.
Yes, I've called the Better Business Bureau. And our senator, and the attorney general, and Blue Cross. And everyone has been made aware of the fact that this glitch has 1) affected our credit rating, since it's been going on for months and I'm now in collections from when I went to the doctor 3 months ago, thinking I was insured and 2) potentially caused permanent injury, since it's my goddamn SPINE and I've been unable to pursue treatment for nearly a month now. But apparently "stuff takes time."
Other than that... I just came back from the International Association of Animal Hospice and Palliative Care conference in San Diego. It was all sorts of amazing, and I wish I could rhapsodize more about it, but right now I'm achy and cranky and wondering what minor Deity of Access to Health Insurance I wronged in a prior incarnation and how to appease them.
I promise to write more tomorrow. About the San Diego zoo, and being at a conference of like-minded souls in the process of founding an entire branch of medicine, and how Scream Queens is the best new show in a decade and short hair means I have an excuse to wear every wrap and scarf I own (in series, not in parallel) and the terrible etiquette of "saving seats" for people and all sorts of stuff.
Right now, though, I'm going to sulk here with my heating pad....
My neck and shoulder are still a wreck. This would be because, ONCE AGAIN, our health insurance is also a wreck. This time apparently a glitch in the MassHealth Connector's computer system insists that, while our payments have been received, the money hasn't been sent to Blue Cross, so we can't be activated in their system. This is in spite of the fact that Blue Cross acknowledges that they got the payment from MassHealth - apparently both BCBS and MassHealth believe they have our money. But since the MassHealth system lists the payment as not having been passed on, I'm up the creek. And this is apparently a big enough glitch that it's taking them a long time to fix it.
Yes, I've called the Better Business Bureau. And our senator, and the attorney general, and Blue Cross. And everyone has been made aware of the fact that this glitch has 1) affected our credit rating, since it's been going on for months and I'm now in collections from when I went to the doctor 3 months ago, thinking I was insured and 2) potentially caused permanent injury, since it's my goddamn SPINE and I've been unable to pursue treatment for nearly a month now. But apparently "stuff takes time."
Other than that... I just came back from the International Association of Animal Hospice and Palliative Care conference in San Diego. It was all sorts of amazing, and I wish I could rhapsodize more about it, but right now I'm achy and cranky and wondering what minor Deity of Access to Health Insurance I wronged in a prior incarnation and how to appease them.
I promise to write more tomorrow. About the San Diego zoo, and being at a conference of like-minded souls in the process of founding an entire branch of medicine, and how Scream Queens is the best new show in a decade and short hair means I have an excuse to wear every wrap and scarf I own (in series, not in parallel) and the terrible etiquette of "saving seats" for people and all sorts of stuff.
Right now, though, I'm going to sulk here with my heating pad....
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... maybe the phase of the moon has come where the answer is "don't call the BBB, call a lawyer." It is, after all, as you say, your dang spine.
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On the other hand, it's the prospective lawyer-victims who have told him this....
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I'm not saying this means you *should* involve lawyers - just that a lawyer from the other side's word is meaningless.
Does your state have an insurance commissioner? They should be consulted, if so.
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You have my greatest sympathies for this horrible situation and the pain it is causing you. *hugs*
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So. My insurance rate mysteriously went down from 2014 to 2015. Because I saw the new rate confirmed in various documents from Anthem (my carrier) and Access Health Connecticut (CT's ACA entity) I believed it was accurate and paid that amount for January, February, March and even April. During the last few days of March I received multiple letters from Anthem telling me that I hadn't been making my payments and my coverage was going to be suspended; I also received a check for several hundred dollars. Color me confused.
So I called Anthem as soon as I saw the letters to find out what was going on. It turns out they raised my rate retroactively, back to January but hadn't told me before. They also told me that they can't accept partial payments, hence the refund check. I am very, very lucky that I'd been paid recently and could shell out over $1000 for past payments via phone payment. They said that I also owed for April -- I asked if I could make that payment in a day or two (after transferring some money) and they said yes. By March 31st I had made multiple payments and was fully paid through the end of April.
And so Anthem's employees would say when I called because, for example, I was told at my pharmacy that the insurance coverage for my prescriptions didn't go through. At the beginning that was a multi-step process -- I'd call the pharmacy people, who'd say they couldn't handle payment issues. Then I'd call the payment people, who would look and see that, despite what the computer said, I had in fact made payments and was fully covered! So they'd remove the payment/financial hold on the account and tell me that everything was cleared. But, if I went to the pharmacy then, I'd discover that it wasn't -- and I'd call the pharmacy benefits people again; they'd then release another hold on the account that was specific to pharmacy benefits and I was good to go.
After a few months I got used to this and would telephone the pharmacy 1) before I went to pick up a prescription to find out if the insurance went through (which it hadn't) and 2) after Anthem said they'd fixed things in their computers. I still owe the Thursday afternoon pharmacy crew a pizza for one particularly frustrating series of calls.
Oh -- and each time I called about this? Whoever I spoke with told me that "everything" was fixed and I wouldn't have the problem again. Poor, simple souls.
So, somewhere in here I needed to go to an ortho doc and get PT for what turned out to be my lower back. A day or two before my first ortho visit I got a call from the dr's office saying that my insurance didn't go through. So I called yet again, spoke with someone, took their name -- by now I was already taking names -- and they told me that everything was fine, they didn't know why the computer was showing that my account was anything but current, and that the doc's office should call Anthem and ask for someone to pull up my account -- they'd see that it was fully active and paid and would tell the dr's office so. Which, in fact, the person did.
Every time I would need to go through this. And every month I'd make multiple calls. I started asking for my call to be escalated, which they started doing for me after I recited my full history of calls back to March. When someone would say something was fully fixed, I'd ask why, then, Anthem's online site would say that my account was "suspended" "pending investigation." No one could answer that.
At some point I spoke with someone who was more aware of what was going on -- he told me that Anthem has three separate, non-integrated systems and that he and his bosses only had access to two of them. He said that he put in a request that the third group fix it -- I think that was at the beginning of May.
to be continued....
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I made one more call and said I needed to speak with J the benefits specialist. She was pretty miffed that the people she emailed hadn't fixed things yet, so she sent them another message *and* called them. That, I'm delighted to say, fixed the problem.
I can't adequately describe the elation I felt when I went to pick up a prescription at the end of July and I did -- no phone calls involved. It was amazing.
I can say we were incredibly lucky -- although I needed medical services, I could speak with the office's people and tell them that Anthem said to call directly because the computer system was screwed up. If we'd had any emergency situations that might not have been able to happen. We were incredibly, incredibly lucky.
And so, in sum, I don't know whether your branch of Blue Cross or MassHealth have multiple, non-integrated computer systems that no single individual can access -- but it sounds like it might be a similar situation. And I don't know whether the phrase "benefits specialist" is meaningful in either system, or whether a benefits specialist there would have the same knowledge and capabilities that Anthem's does. But I'm figuring that, just in case, "benefits specialist" is a term that it might be useful for you to know.
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Plus.... while I'm so sorry to hear that you went through this, on a selfish level it kind of helps to know we're not the only ones that this happens to....
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