Nerdy Dork

I’m furious right now! And as those who know me can attest, it takes a lot to upset me.

Figuring blogging might be a good stress reliever, I’ve come to rant.

Here is the background. Shortly after my wife had our son in March, she somehow strained her neck to the point she couldn’t move. We went to the ER hoping there was something they could do. She was given some muscle relaxers and pain relievers. Neither helped much. She saw her OBGYN the next week. He sent her to a Physical Therapist.

Now, my wife used to work for a world class orthopedic hospital that she much would have rather gone to. But since we have Blue Cross & Blue Shield (BCBS) she knew she couldn’t go there and have our insurance cover it. I don’t know for sure, but my guess is that if she would have gone there, they would have helped her out for free. They’ve helped me out for free in the past just because I was her husband.

So my wife went to this run down rehab joint that she was referred to and got a back massage and some exercises she was told to do. It help and her neck recovered, but then the bill came for $164.00. This isn’t huge, but according to our medical plan we would expect to only pay 10% of that. After BCBS of Minnesota proccessed the claim, we were told that they were not BCBS providers and therefore we were responsible for the $164.00.

Now, here is where it gets ugly. I used to work for IHC Health Plans, first as a customer service representative, then as a claims processor. Figuring all health plans to be somewhat equal, I called Blue Cross of Minnesota and explained my situation.

Now, had this been me, at IHC I would have just said, “well, you did all you thought you were supposed to do. In the future please don’t go to that rehab place again or else you will be responsible, but we’ll go ahead and make a one-time exception and process that claim as if they were in network.” Then the customer would be delighted, and thank me profusely and hang up happy. You see, at IHC, we as customer service representatives were given the authority to grant one-time exceptions up to $500 at our own discression. Certainly a case like this would warrant such.

Well, I’ve since learned that not all health care plans are created equal. After explaining my situation, I don’t think the customer service rep believed me to begin with when I said that my wife was referred by her OBGYN and that they told her that this rehab center was participating on our insurance plan. She said she would call their office to confirm this referral and get back to me.

Three days later I got a phone call from the BCBS customer service representative. She said that she confirmed that my wife was referred by the office, and the office did believe this rehab place was in our network, and so she would send the claim back to have it re-process and paid according to our in-network benefits.

Well, it’s been two months now, we’ve recieved two more past-due bill notices from the rehab place, yet no word from BCBS. So I called them back today to check the status. Believe it or not, the lady I talked with today was not friendly at all - even from hello! She looked back at my history and put me on hold to speak with the other gal that had told me that my claim would be paid. She came back and said something to the affect of, well, they might be “participating” but that doesn’t mean they are “PPO providers,” therfore, we can’t pay this claim. She just kept saying that over and over which made no sense at all. Apparently the fact that I had been previously been told that this would be paid made no difference whatsoever. Apparently they had changed their minds and didn’t even consider telling me this.

So, out of frustration from speaking to this lady I asked to speak with her manager for a better explaination of the conflicting resolutions. I was told that she was very busy. I said I would hold, thank you. After holding for a minute or two she came back and asked if she could just transfer me to her manager’s voicemail. Sure.

I left a message and that is where it sits today. I suppose I will now go ahead and pay for this bill. It’s really not this shabby rehab place’s fault that my insurance company sucks by all means and has no concept of customer service.

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