“Can you just tell me if I’m covered now?”

Two different “customer service” reps at Highmark BC/BS really couldn’t answer that question for my husband yesterday — the latest in a months’ long saga whose ending is still to be determined.

A couple months ago, my husband’s employer got word that Highmark was dropping the “small group” health insurance plan the company had been enrolled in for several years. Mike is the only one of the company’s five employees covered, as his colleagues are covered under their spouses’ plans. Coverage would end as of May 31, and the company needed to find an alternative. Because Mike is the only one affected, his employer left it to him to research other plans and present them with some options. Mike has been a Highmark customer for years, and his medical history is clearly documented with them, so we thought this would be a relatively easy process.

How foolish we were.

We quickly learned that almost all of the available options were more expensive for less coverage than he was currently receiving. We’d likely be hit with high deductibles and copays, on top of hefty premiums. His only hope was to enroll in the same “individual HMO” I’ve been enrolled in for 10 years (which I pay for myself, being self-employed).

I learned, much to my surprise and annoyance, that if he was accepted, his monthly premium would be significantly less than mine (like $40 less) because he’s a man (even though he’s a year older and I’m way more health-conscious than he is and have been enrolled for 10 years) — so ladies, another form of discrimination rears its head (supposedly because of that nasty malady called childbirth some of us are prone to — but not me. Oh, and does that mean my premiums will go down once I hit menopause? Yeah, right.).

Unfortunately, his “pre-existing condition” (allergies) caused them to deny his application (even though they know precisely the extent of his treatment, which is in no way extensive). He even had his allergist write a letter of appeal — nada.

I’m skipping over the numerous phone calls it took to even get information on available plans and find out just when he could begin the new enrollment process and what that process would be. Literally — it took several phone calls to several people with varying degrees of knowledge. (And various forays into the Highmark Web site — exceedingly buggy and hard to navigate.) Along the way he discovered that one arm of Highmark still had his old address from 4 years ago (while other arms had our correct address).

Seems Highmark would be sending a “magic letter” two weeks before the end of May when coverage would officially be dropped. Once Mike got the magic letter, he could enroll in another program, BUT NOT BEFORE. Don’t even think about trying to enroll before the magic letter comes.

In the meantime, Mike’s employer gets an invoice for June’s premium under the old program (which is ending May 31st, mind you), which they pay.

May 31st comes and goes and no magic letter appears.

So, Mike calls Highmark for the 437th time yesterday, only to get repeated messages that customer service is down. Great, he can’t talk to anyone. After a couple hours, he finally gets through. One rep tells him: “Yes, your plan has been canceled. But no, I don’t see that any ‘magic letter’ has been sent.

(So, if you haven’t gotten the letter, are you still without coverage? And if a tree falls in the forest…)

“But my employer got a bill for June and paid it.”

“Oh, they might just get that refunded [because the plan has been cancelled].”

“Can you just tell me if I’m covered right now?” he asked in desperation.

The best answer he could get was, “Well, there is a 90-day grace period after your coverage is dropped.” Although there was also some talk they might deny any claims submitted in that time and he’d have to argue about them…

Oh, and there’s the fact there’s no coordination within Highmark — current coverage questions and new program questions require speaking to different people, who don’t have the same information and apparently don’t even see the same “screens” on current subscribers. And apparently, if a rep doesn’t know something, there’s no way to get “bumped up” to a supervisor who does know something — I’m thinking such people (those who know something) don’t even exist.

So, we’re still waitin’ for the magic letter, as nothing can happen without that. And of course, no one knows why the magic letter hasn’t been sent or when it might be. Or if it WAS sent, and we just didn’t get it. And we still haven’t worked out with Mike’s employer what we might be responsible for paying under a new, more expensive plan. So we’re waiting for that hit too.

How timely that this morning’s online WSJ had this article about health insurance. I sure don’t think nationalizing it is the way to go (God forbid, not more government involvement in our lives), but something’s gotta give. For once, I hope it’s not hard-working consumers.

Bureaucracy is a giant mechanism operated by pygmies.
~ Honore de Balzac


  1. jewels said,

    Thursday, June 4, 2009 at 3:38 pm

    I feel your pain! We pay a lot of money for family coverage from our insurance since Dave is considered self-employed and every time we see the doctor or change something, I am on the phone with them fighting to get them to pay the full amount. Yesterday I called because they said the girls had seen the doctor for their annual visit ahead of when they went last year (apparently you have to make your appointment AFTER an entire year…it does not go by calendar year). Fortunately they have a 30 grace period and our appointment fell into that window. Otherwise I would have been out hundreds of dollars. Can you believe they get away with this stuff!! So frustrating…

  2. WritingbyEar said,

    Thursday, June 4, 2009 at 4:05 pm

    Geez, Jewels. I knew about the 1-year rule only because my OB-GYN always warns me about it re: my annual mammogram. Glad you lucked into the 30-day window (who knew they had that)? I could understand some of this if we had never been Highmark customers before. But now it’s like we’re starting from scratch with them (Mike who?).

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