Federal Health Insurance & Customer Service Nightmares

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BeachPerson
Posts: 1045
Joined: Sun Feb 25, 2007 5:39 pm
Location: Northern VA

Federal Health Insurance & Customer Service Nightmares

Post by BeachPerson »

In the late 1990s, Blue Cross/Blue Shield had a bad reputation for paying doctors small amounts and paying late. My doctor then said he would no longer accept Blue Cross/Blue Shield. Now my chiropractor loves Blue Cross/Blue Shield. They pay on time and do not nit pick over small issues.

Eight years ago I had Mailhandlers that uses AETNA. With Federal supplemental dental insurance the procedure is to bill the primary health insurance and then send the EOB to the supplemental dental insurance. I use a different federal dental insurance that is the best for implants so the process is not automated. It took six months of calling Mailhandlers every two weeks just to get an EOB of $0.00. I was kept being told it was coming. Finally a rep knew what I wanted and sent the EOB to me. Such a nightmare I only went to the dentist once that year.

Now retired, I have Compassrose that uses United called UMR. To do volunteer work in a hospital I needed for blood tests to prove that I had mumps, and measles vaccines as a kid. With the cost estimator tool:

I pay $4
UMR pays $36

I had the tests done back in July.

Quest bills me for $493 since the bill was rejected. Quest keeps sending me and UMR bills. I am good at telling Quest what is going on.

UMR rejected my claim. I called UMR and my doctor put in an obscure code. UMR said to use the employment code. I tell this to the office manager and a mixup with another wrong code.

I got the right code from UMR and had the doctor put it in, and now UMR says a reason for the code change must be entered. Also a reason for the blood tests must be given. After each time, UMR waits 45 days. I meet with the office manager on Monday.

When doctor's change a code, does the software application ask for the reason for the code change?

Blue Cross/Blue Shield is more expensive, but next open season, just might go back to them.

Anyone else have nightmare expenses on billing issues?
From Jack Brennan's "Straight Talk on Investing", page 23 "Living below your means is the ultimate financial strategy"
stan1
Posts: 14100
Joined: Mon Oct 08, 2007 4:35 pm

Re: Federal Health Insurance & Customer Service Nightmares

Post by stan1 »

I don't know, it sounds like the tests were not medically necessary and were for non-federal employment? Seems like each plan might vary on how that is handled. Too bad the hospital didn't just send you to their lab and comp you a mumps test.

My dentist cannot produce a zero balance statement that is compliant for my Flexible Spending Account. I won't describe further what I do.

This is all normal these days, everything has gotten so complex with decades of software automations that even good CSR's sometimes struggle to keep track of all the exceptions and troubleshooting. Not sure if AI will solve it, or AI will drive some massive simplification initiatives. It's the age old business problem of fixing an inefficient process before further automating it.
gotoparks
Posts: 988
Joined: Sat Jan 28, 2023 9:19 am

Re: Federal Health Insurance & Customer Service Nightmares

Post by gotoparks »

It's funny we all have different experiences. I use BCBS Federal and it works well. Most doctors in my area take it. My Chiropractor dropped them and now I pay out of pocket for him. I fill out the forms to get reimbursed but only adds up to one visit reimbursement.
chalet
Posts: 233
Joined: Wed Aug 28, 2019 9:59 pm

Re: Federal Health Insurance & Customer Service Nightmares

Post by chalet »

this spotlights one of the good things about FEHB. you can change insurance companies every year if you want. for any reason.
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pahkcah
Posts: 412
Joined: Tue Dec 15, 2015 9:50 pm

Re: Federal Health Insurance & Customer Service Nightmares

Post by pahkcah »

DW and I are both retired Feds. We both have BCBS (Basic) and Medicare Part B. Other than the premiums and co-pays for prescriptions, we've never paid another penny or had paperwork of any kind to worry about.
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