I am sitting down right now at the computer in the business center of my apartment building and praying. I am praying as I type this that I will have the clarity to explain to all of you and to the California Department of Managed Healthcare why Blue Cross of CA should be held accountable for their wreckless and dangerously disorganized practices at the very best…or at the very worst, their intentional deception and fraud perpetrated on consumers.
For those of you close to me, you know the battle I have waged over the last seven months with this company. It has been one thing after another. From not being able to verify coverage for me, to not being able to provide me with an in-network specialist…and now…
The short, non-detailed version of what I intend to convey to the CDMH is this: As a participant in in the High Deductible Health Plan (HDHP) that Blue Cross provides to Issa’s employer, we have a choice (being in a PPO) to select either in-network or out-of-network providers. Our deductible is higher for out-of-network (OON) providers, as is our maximum–and none of the money spent on OON providers counts towards our in-network providers meaning that we have a toally separate deductible liability to see the regular doctor for a headcold or for an emergency room visit.
Because I needed to see a specialist, and Blue Cross was unable to refer me to an in-network provider for close to two months, we decided that I should see one that was out-of-network. As it turned out, I required some minor surgery, to be completed at another OON facility where my OON physician had privileges.
When the facility called to verify benefits, the insurance company confirmed that we were covered…that X amount of our deductible had been met, and that the amount we would be owning for the procedure was X amount of money. I, myself, called later when more of our deductible had been met to try to determine how much would be due on the day of the surgery so that I didn’t overpay significantly since we had a number of medical bills being processed from my OON physician…AND since the amount we were paying was substantial I didn’t want to pay more than we had to.
Never once was I told that the maximum that would be paid for an out of netwrok “Ambulatory Surgical Proceedure” was 350.00 dollars. Never once was I refered to that section of my policy, never once was I informed that the balance…over 2400.00 would be my responsibility, would not count towards my deductible or maximum….
We operated under the impression that the procedure fell under “All other specialty procedures” for which the limit was 25,000 per lifetime!
So, I hope that was clear because there has been so much smoke and mirror type stuff on behalf of Blue Cross that there are far more confusing details that I chose to leave out but they leave my mind cloudy and uncertain of which details are important and which ones aren’t. As it stands I have the equivalent of a full-time job just trying to get the services I contracted for. What they have done is a crime, in my books…and it should be a crime to the rest of society as well.
