The Joys of Managed Care...

THIS IS A TRUE STORY

A patient was scheduled for an appointment in February 2008.

Called Blue card eligibility with the three letter prefix NLA which sent me to BCBS of SC.

I spent over 30 min in the BCBS of SC VRU (Voice Response System) trying to obtain accurate, complete mental health benefit information and trying to talk to a representative. The VRU would never let me talk to a rep and it would not give me an option of mental health/behavioral health/ psychological benefits. Only psychiatric which pays at 90% after satisfying a deductible.

After the initial appointment, testing benefits were required so called again morning of 03/13. Spent over 45 min in the VRU trying to get to a person to answer questions that were not given in VRU. Kept saying, “You cannot access the rep until you have received all benefit information.”

I accessed every kind of benefit information there was available including pediatrics and maternity. Asked for a rep and it said, “The office is closed from noon to 1 for lunch. Please call back after 1 PM.” I have never called to verify benefits at a major insurance carrier and been told the office was closed.

With extreme dread and trepidation, I called the BCBS of SC again after 1. Went through the VRU again, including asking for the benefit information to be faxed. Even after getting every stinkin’ bit of benefit information available it would not let me speak to a customer service rep. Kept saying, “You must obtain all available information from the VRU before speaking to a representative.” And then it simply hung up.

I decided to call the patient’s mom and see if she had any additional information that would be helpful. Otherwise I was just going to tell her it was impossible to verify benefit/eligibility/authorization information and I needed her to pay in full at the time of service.

I called work, since it was before 5 and got an answering machine. I called home and got an answering machine and started leaving a message and it cut me off mid-sentence.

I went to the BCBS SC website and selected “Contact Us” but under that screen it only lists Q & A stuff. There is no email, phone number, fax number, nothing in the way of contact information.

Then I noticed that the fax I received from BCBS of SC had the heading of BCBS of MI.

I accessed BCBS of MI website and selected the “Contact Us” section. There was no number, no fax number, no email listed. It said, “Look at the back of the patient’s card for the correct phone numbers.”

Called secretary and asked her to look at the back of the patient’s card. She gave me one that said “For benefits and eligibility call…….” And another that said, “For mental health benefits call…….” I said, “Does it say BCBS of SC or MI or what. She goes, “It said BCBS of AL PPO.”

I called the mental health number and got a recorded message that said, “You have reached Audix. Please leave a message.” Strange. I don’t know what Audix even is.

I called the benefits and eligibility number and got, “This is Sue. Please leave a message.” This can’t be right!! Where is Rod Serling? I must be in the Twilight Zone!

I call BCBS of GA, who paid the claim to see if they have on record who the member's plan is actually with. They do not.

I check the numbers again and make sure I wrote down the right ones. I did. Well maybe, even though I’m using voice dial, maybe I said the wrong number. So, I called the mental health one again. Same thing. I call the eligibility one again and get a person who says “Such-n-such financial services, can I help you?” And I go, “I know this sounds strange, but I’m trying to get insurance benefits on a patient.” She says, “You’re trying to reach BCBS aren’t you?” I go, “Yes! Happy to actually hear another human being’s voice.” She goes, “We are still getting calls for folks looking for BCBS. This is a financial services office, but this is the number they gave us to give out.”

I call the number she gave and I get another real person. Exhausted and angry I go, “I am desperately trying to get benefit and eligibility information on a patient. “ She starts asking me all these strange, unrelated questions. I finally get suspicious and go, “These are not the customary questions asked to obtain benefit information.” She goes, “This is the Human Resources Department for employees of BCBS of TX.” I AM NOT MAKING THIS STUFF UP!!!

I bust out laughing and go, “Do you know how I got your number?” ...and I explain how there is a number on the back of a bunch of insurance cards out there that are a financial services office. The financial services office gives out your number to folks looking for mental health benefits and eligibility for patients with……Gosh I don’t know, maybe BCBS of SC, MI, AL, TX. Who knows?

She says, “Well, here’s the number I have for BCBS of AL.” I call that number and it is for members, not providers and it gives me another number.

I call it and it gives me another number. I call that number and the office is closed….it’s 5:05 in AL.