Many automated call centers (not just in health care related businesses) make it very difficult to get to an agent in order to get service on a topic other than the common ones that you can press the phone buttons for.
As far as the speaking English part, some offshore call centers have people who speak English very well with some type of “American” accent. But those probably cost more than the ones with lower standards for speaking English to callers from the US. I.e. the obviously offshore agents who are difficult to understand indicate that the US company contracting the call center is going for the cheapest possible option.
One company, Blue Cross and Blue Shield Association, licenses the name to companies operating in the various states. Those companies operating in the various states include some non-profit companies and some for-profit companies.
The BCBS affiliate in Hawaii is a single state non-profit company. An example of a multi-state for-profit company is Elevance / Anthem, which owns BCBS affiliates in several states.
What it means in practice is that a BCBS affiliate company in one state may be different from a BCBS affiliate in another state, which can mean different levels of customer service and the like.
My daughter was born very prematurely and had many procedures and doctors. To make things more complicated the hospital was a combo of Kaiser and ‘regular’ and sometimes a Kaiser doc would care for her if he was on call.
When she’d been there about 4-5 weeks, I started getting calls that bills weren’t paid, both from the hospital and from doctor’s offices for surgeries. The hospital called me to tell me ‘her bill was really getting up there.’ I asked what they wanted me to do, write a check for $200 grand? Well, they suggested I call the insurance company. No, it is an HMO and YOU should call.
I also got a bill from a doctor that came on the bills that are printed through the envelope and you ‘burst’ the sides to see what the bill was for. Except that the bill was so long that it often took 5 or 6 pages, so that meant 5 or 6 bills that all arrived the same day. I threw them all in a box. Then I got call from the office and I told them to stop sending the bills to just sue me. “Oh, that would be a big problem for you.” No, I said, I’m a lawyer and I have nothing else to do right now so I can go to court. And by the way, I don’t know anything about this surgery, I never met the doctor so make sure you bring him so he can testify that he really did the surgery and all about the need for it and why I should pay and not the insurance company or medicaid; she had not only private insurance but medicaid (because of her birth weight) and I thought maybe medicaid would like to know about these collections practices.
Never heard from them again.
When I did have to contact the insurer, I learned to ask for ‘Bill’ right away. I think ‘Bill’ was their version of Judy, the Time/Life operator (the generic name for a supervisor). If they wouldn’t give me to a supervisor, Bill, I just start spewing all the horrible things I’d been through and I’d immediately get connected to Bill.
I recently called our insurance’s customer service several times to determine what hoops we needed to jump through for a particular kind of testing. Our coverage is through GEHA, which was pulled under the umbrella of UHC several years ago. All the reps I spoke with were pleasant, but it was very clear the first (and the second, because I didn’t trust the first) were reading from the plan brochure and either weren’t understanding my follow-up questions or didn’t want to deviate from whatever canned response they looked up. The third was wonderful, had a back-and-forth conversation, was empathetic, even gave some tips for finding providers (including the “magic” wording to see if the testing would be in-network because of the whole GEHA/UHC thing). As we closed the conversation, I asked if it would be possible to contact her directly if I had further questions. Nope! Just another flaw in the system–although if it were possible, I’m sure her direct line would be ringing off the hook.
As a sidenote, we proceeded through the testing as directed, and last week I received a “copy of a letter sent to your provider” saying UHC has no record of pre-authorization. The provider had assured me they jumped through the necessary hoops, so honestly, I’m ignoring the whole thing for now. But I won’t be surprised if the services we paid under $200 for suddenly result in a bill for 10x that amount. Maybe yes, maybe no. Our healthcare system is nonsense.
This is certainly true in Massachusetts - as the companies go, BCBS of MA was much less painful. I always ended calls to them with, “thank you for being a pretty good company even in this marketplace”. I have been known to tell certain other companies’ employees, “you work for a horrible company.”
Well, the good thing about the local BCBS is that it can use all the contracts negotiated by other BCBs but I can still go to my local office to get things straightened out and talk in person to a live person. That ability to talk to a live person is important to me.
BCBS is the company that is currently screwing over my D.
Oh, so sorry, our mistake, sorry for the inconvenience, chose a different PCP, our system shouldn’t have let you choose yours months ago. We don’t give a (insert expletive) that you’re mid-treatment.
So sorry you’re getting the runaround. That’s awful! Is there a way to escalate to talk to a supervisor? I’ve sometimes found that helpful, as they have powers that the regular customer service folks don’t have.
One thing I’ve been doing recently when talking to my BCBS and having a productive conversation is asking them to make careful and detailed notes on my file so we don’t have to go over the same information when I call again or anyone calls on my behalf (like the provider). They’re willing to do this and it’s easier than trying to get the same agent next time an issue arises.
When our son was born Anthem BC/BS screwed up in a different way. They were sending us duplicate checks (younread that right…two checks) for each claim. We are talking thousands and thousands of dollars. We mailed the first couple back…and they resent the duplicates to us. This escalated up to some higher level, and we DID get a dedicated phone number for a specific person to handle this case…which they audited three times.
In the meantime, we were advised by our lawyer to put the second checks received for each claim into a dedicated account…so we could easily account for them, and send back.
This eventually got resolved…about a year later. I’m not kidding.
We even sent them spread sheets, copies of the duplicate checks, etc. They had to complete their internal audits first (the first two said there hadn’t been a mistake…we said “try again”).
Insurance is still a state regulated industry. You can’t shop around and buy insurance in Idaho if you find a better deal. BCBS may have offices in different states but they aren’t all the same company.
My friend’s son was in college in NY and did something to his knee. He got emergency services and they were covered but when he wanted to schedule therapy it would have been out of network. It was cheaper for him to fly home during the semester (spring break and I think one other long weekend) and get therapy than to pay out of network. I think it was BCBS but may have been another major insurer.
Maybe it’s just me…but the coexistence of this thread, alongside other CC threads obsessing about whether perfect scores and a schedule full of activities are enough to get our best and brightest into tippy-top schools, is striking to say the least. The meritocracy has us (me included) scrambling for top spots for our loved ones, but are we pausing enough to ask what kind of world this system is building or what kind of people it’s shaping us, and our children, to be? Juxtaposing the various cc threads this morning has left me speechlessly staring into my coffee….
Prior to the passage of the ACA, therapy for autism was not covered. It wasn’t proven to help, people with autism were not going to be cured - after all, we couldn’t expect insurance to cover a therapy that doesn’t result in a cure, right? The CEO of a very large employer in my state was trying to lead the charge to get companies to provide coverage; he has an autistic child. After the ACA was passed, the issue was not enough therapists trained in ABA. Just when it seemed like maybe autistic children could be properly served, insurance companies are finding ways to deny coverage again. So heartbreaking.
We are covered because H was a federal employee for 45 years and therefore we can be covered as a retired federal annuitant. There are a number of different plans to choose among and every winter, there is open season for a time window, as well as when there is a “qualifying event.” Some other employees have chosen to get a nationwide BCBS plan that reimburses a portion (or all) of your Medicare premium or a HMO plan but so far we have stuck with the local BCBS plan—we prefer the plan and company we know (and that insures about 80% of our state) to unknown and national options.
