Today I again found myself on the phone with BCBS Plantinum plan customer service discussing why my children's eyecare wasn't covered. The explanation of benefits (that paper you get in the mail that you dread opening because even though it isn't a bill it proves your gonna one on the way) said it wasn't a covered service on the member's plan. So, I'm on the phone with the representative and she explains that isn't why BCBS did not pay for the doctor visit. She states it was because of the coding. So, together we went over the coding. Then she put me on hold long enough to fix my 4yr old food (thank for speaker phone) and answer another call to tell them I was holding for BCBS I'll call them back and a nap. Just kidding on the nap. So, the official word from the Plantinum Plan BCBS Customer Service Supervisor is that BCBS computer system is messed up. Even though they thought it was fixed, and cannot understand why it continues to process claims wrong, it was my lucky day because they decided that they would process my children's doctor visit claim as my plan does cover the eyecare. I told them they could call the President to verify the Obamacare coverage requirements (which BCBS helped write) if they needed to. However, again it was all a misunderstanding (according to BCBS). I don't feel that I misunderstood anything. I got a bill I shouldn't have to pay and called the insurance company and waited on hold all day and talked to one representative who had to verify with another BCBS representative with a title of "supervisor".
The good news is, that when I was done with this phone call I got to call BCBS Platinum Plan Pharmacy Department (AKA Prime Theraputics) to discuss why I was charged $1.88 for my child's prescription which should be covered at 100% on the Platinum plan. Well, apparently I was just overcharged a little over $72.00 after talking with them for a while. I never had to be put on hold. That representative understood how to use a calculator to come up with the fact BCBS Platinum Plan wasn't doing the job right. She didn't bother to blame it on the computer either!
So, for anyone out there with a Blue Cross and Blue Shield Platinum Plan, check all your claims. Apparently, down to getting your blood drawn! If you go to the doctor and they take your blood you better make sure the lab they send it to is in network or your going to get an EOB saying your going to be billed for One Thousand Five Hundred dollars like I did! Also, you are going to want to ensure that when you get a denial you call them right away to explain their own plan to them so that they can explain it to their computer. Also, you will want to ensure that you either have all day to handle a question for this plan, or be a good multi-tasker.
Remember, you can get all this and more for the bargain price of around $800 ish a month. Gee, I wonder what the Gold and Silver Plan customers go through? I bet they need to plan for several days vs. hours on the phone and a computer that is harder to program so it will take more than just a supervisor's approval. I'm not too sure, but at least they will fix it. Eventually. At some point. Soon I hope. Well, maybe I should call them and ask them how long it will take? I mean this is almost 6 months into the year here, so maybe this will get handled by Christmas? Wonder if that is what happend to Santa....I can hear it now. "You see kids, well, it is just that poor Santa Clause was on the Gold plan and the reason he didn't come this year is because the computer is still being built to process his healthcare claims."
I signed up for the Dental plan with them as well, which I'm getting ready to use. I'll let you know how that goes and if the Tooth Fairy will be missing for a while. :)
To Be Continued. Please Hold.
Big Sugar to All my Five fans!
