Victory is Mine!

My head is held up with pride today, and I'm smiling internally.

Thanks to the 15-month old, multi-state Insurance Company Victory that's finally come my way. Finally.

It all began in January 2010. At least, that's when the issue surfaced and came to my attention.

Upon receiving a bill dated Jan. 5, 2010 in the middle of the month, I learned about a billing dispute for an order of One Touch Ultra Test strips. They were ordered Dec. 29, 2008. Yes: 2008. I'd received that box of strips without any problem within a few days of that order, and more than a year later this was the first I'd learned about any problem. First issue.

The second and most significant concern came from the tab at the bottom, which pointed out that I owed $675 for my three-month supply of mail-supply strips.

At first, I laughed. Really, I did. The words "WTH" escaped my lips, along with a head shake, but I was at that point really more amused than anything. It's sad that I've dealt with these insurance company nuisances way too often, and they've almost become expected. Still, it always is interesting to see what new and creative ways they can screw up the most simple of items.

Investigating the bill, I see that "insurance pending" is $0.0. So, for some reason, my insurance company at the time denied in full the claim for these covered test strips. So, this supplier was simply billing me for the amount owed to them. Further analysis showed that the claim was first submitted 4/09/09 (more than 3 months after my order) and rejected. They tried again 6/9/09 and again the insurer rejected the claim. Apparently, no other action happened - if it did, it wasn't reflected on this statement.

At the time, I had insurance coverage through my wife's work that had been in effect from our marriage date of Sept. 2005 to April 14, 2009. Clearly, I was covered for something ordered in late 2008. After that insurance, I was immediately covered by my own work's policy for several months, until she was able to get onto another plan through a different employer and my coverage began there.

Now, my mind revolved around the two submitted and rejected dates in April and June 2009 - the first said it was submitted to Anthem, which was NOT the company I had at the time. Actually, my insurer then was Blue Cross Blue Shield of Michigan. While they fall under the same Wellpoint/Anthem/BCBS network, they all emphasize how seperate they are and how one is not related to the other as far as coverage goes. However, the supplier may have tried to submit this claim to the wrong company and it was denied. Then, two months later after my insurance coverage had changed, they tried again and were denied.

"Morons," I muttered.

Within a day or so, I phoned the supply company in Kentucky. Person A assists me. Explain the issue of receiving bill, not hearing anything before this since my order, and clearly pointing out that my insurance at the time has since changed twice. The woman on the phone explained that it had been submitted, and told me I'd have to contact my insurer Aetna about why coverage was denied. First, I didn't and have never had Aetna as she stated. Apparently, she looked at the screen and saw an "A" company and then entered that into the notes area while speaking with me. (WOW... And we wonder why...) Person A then declines to tell me what insurance information the Supplier had submitted, saying that it's "correct" and whatever policy information we have on file.

Um, no Lady. If you can't even realize there's a difference between Aetna and Anthem and screw that up, how can I possibly trust you to get anything right? Billing Error on your part, not mine.

 I tell her this is important, and likely a cause of the billing issue - since my policies had changed, and the Info on the statement was to the wrong insurer. After hearing that her supervisor probably wouldn't be too happy to hear she was coming between Her Company being paid, she became more helpful. Sure enough: the insurance information was wrong. They'd somehow managed to combine the letters and numbers of my two policies, the one in effect in 12/08 and the later one that began after 4/09.

Idiots.

Person A "corrected" this and said it would be "resubmitted" for review. I again emphasized that they needed to contact the correct insurer at the time of order, not my current one that's different. It wasn't clear whether Person A actually understood this.

This was also about the same time I needed to order more test strips, but I decided to not add to the mix and confuse them even more, so held off on that for another day until this was more fully resolved. That ended up leading to another issue, which isn't exactly relevant to this tale (but that's been resolved in the meantime, too).

Anyhow. More than a week went by and I hear nothing. So, I phoned back.

Person B has no clue who I am or what I'm talking about. I recap it briefly, and she almost exactly reiterates the phone discussion with Person A. It all begins again. She promises to get right on this. A week later, I phone again after hearing nothing and leave a message. Two more messages within the next week, and nothing in response.

At this point, it's Groundhog Day. My Blood is Now Boiling, elevating gradually from that Initial Headshake and Laugh to Simple Annoyance to this point.

Finally reaching Person B again, I learn that BCBSM denied my claim most recently on Jan. 12, saying I wasn't "eligible for benefits" at that time in late 2008. Assuring her that this isn't my mistake, but one between Them and the Insurance Company, they should clear up in order to get their due money. Person B explained that she was graciously assisting me instead of just leaving it to the Direct Billing Process while I work it out with my insurance company.

Even though it was initially their mistake in submitting the wrong insurance policy numbers.

Once again, I explained (again) that I was not covered by Anthem at the time, but by BCBSM, and even though they're owned by same parent company, we're talking two different entities. I had in my hand my Certificate of Continuous Coverage from BCBSM, stating specifically that my coverage extended from 9/05 to 4/09 - clearly the Dec. 08 date was covered. Faxed it to her. Person B was baffled upon seeing my documentation, not understanding how it's being denied when I was clearly covered. Person B tells me she'll have to talk with her supervisor, re-submit to an insurance company supervisor, and that it could take up to 30 days.

Fine. Whatever. This was Feb. 5

After reading recently about Kerri's insurance coverage headaches and others' comments, I decided to check in and see where this stood - the 30-timeline wasn't up, but I hadn't heard anything and was curious.

On Tuesday, I phone Kentucky and reach Person B. No clue who I am, but I recap the issues and she recalls it all. Checks, and says nothing. She decides to push further - I'm on hold for 10 minutes in the middle of my workday. Eventually, she returns and tells me that Anthem/BCBSM has approved the claim. Instead of the total $675, the insurance company is paying $314.15 and my co-pay will be $34.90. This is all thanks to a contracted provider discount system, so that's why it's so much less than the full price.

Person B tells me that she is pleased to have gotten this resolved, and still can't understand why BCBSM or any Insurers just reject claims initially. They put up a fight, and most of the time, it's without merit.

(Sigh. Hello, choir. I'm your preacher...)

While this is one small example of the routine headaches we PWD face in our Living With Diabetes Adventures, it should be fairly noted that: my co-pay comes out to about 11% of the discounted total, which is roughly 46% of the actual total cost for these strips. Overall, my former insurance plan allowed me to come out of this all by only paying about 5% of the total total. This is incredibly important. While Frustrating and Much Too Convoluted & Burdensome, it is beneficial and needed. This is why our Congress and leaders must carefully examine this whole process when considering reform.

So, that's settled. Finally. After all the headaches that shouldn't have been necessary, I win. I like winning. To quote Stewie Griffin: "Victory is mine!"