Blues in the face

Blues in the face

One of the ways insurance companies make money is to try to offload claims costs onto other parties. I had a surgical claim last year and somehow Blue Cross Blue Shield of Massachusetts’ computer thought it met the criteria for further investigation.

I received this letter yesterday:

Dear David Williams,

Blue Cross… [has] asked Accent Insurance Recovery Solutions (“Accent”) to help ensure accurate and appropriate reimbursement of medical expenses that may involve a third party. We are in the process of reviewing claims to establish if a third party was at fault and responsible for the treatment to you (or your dependent). This is our second request for the information so your prompt response would be greatly appreciated.

The letter goes on to provide a variety of ways that I can respond (phone, mail, fax, web). It was signed by Elizabeth Taylor (a Third Party Liability Specialist for Accent — I always wondered what happened to retired entertainers).

Problem is, I got this exact same letter a couple months ago and responded by phone right away. I spoke to a rep that time; after she confirmed the claim had nothing to do with an accident or third-party payment she told me I was all set.

This time, I called the number again and didn’t have the option to speak to a person. The multiple choice questions didn’t really cover my situation, so I called a separate customer service number and spoke to “Holly.” She had no record of my original interaction but assured me that my account has now been closed out. I wonder if I’ll get a third letter.

This is tedious enough for someone like me. But imagine the hassles for people who have lots of more complex claims for serious conditions. Dealing with the condition is taxing to start with, but the paperwork makes it worse.

Proponents of single payer systems often cite administrative cost savings as a reason to shift away from the system we have today. The argument is overly simplistic, but extrapolating from my experience to the experience of physician offices, hospitals, and other patients in dealing with payers and their agents I can see that there is something to it.

March 27, 2006

Leave a Reply

Your email address will not be published. Required fields are marked *