Monday, March 7, 2011

A health insurer admits it's wrong

It's not often you hear something nice said about a health insurance company, but Anthem Blue Cross just earned a bit more respect from me.

I recently had a disagreement with Anthem over a health insurance claim it declined to pay. But after reviewing the issue, the company – a drum roll, please – changed its mind and paid the bill. The amount involved was just $62, so perhaps this doesn't mean a whole lot, but I think there's lessons to be learned in this experience.

Here's what happened: My 9-year-old daughter went to the doctor in July 2010, and some tests were sent off to be handled by Long Beach Memorial hospital.  For some reason, Long Beach Memorial didn't get around to billing me for the tests until October.

I typically pay little attention to medical bills the first time they arrive because it usually takes a little while for insurance to kick in. If you just wait a month, insurance will often pay the whole bill, or at least determine your share. When the second bill came in November, and insurance hadn't taken care of it, I probably should have paid closer attention, but I did nothing until the December bill came with still no action from Anthem.

At this point, I called Long Beach Memorial and discovered that they didn't have our insurance information. So I gave it to them, and figured that would settle the matter.

A few weeks later I received a statement from Anthem related to this bill. I only looked at the bottom line, which said we owed nothing, so all seemed fine.

But I soon got another bill from Long Beach Memorial. At this point, I took a closer look at the statement I had received from Anthem and found that they had not paid the bill. Rather, they had denied the claim, saying it had been submitted too late.

I called Anthem and found that Memorial had five months to submit its claim, but because the hospital didn't have our insurance information until December it had finally sent it in two days late. Anthem denied Memorial's claim, but Memorial still wanted to be paid, and I can't say I blame them.

It seems to me that all parties can learn something here. If Memorial had sent its first bill more promptly, or if it had contacted me or the doctor's office to get our insurance information, this would have been settled without a problem.

I was guilty, too, of not paying adequate attention to the bill.  Had I called Memorial a month earlier, again there would have been no problem.

That said, it seemed that Anthem was trying to wriggle out of its responsibility on a technicality. This was a legitimate medical bill, exactly the reason you have health insurance. Yes, the claim was submitted five months and two days after the service, but so what? What's so magical about the five-month mark?  It's still a legitimate claim.

I submitted a "grievance" with Anthem, but honestly I didn't expect anything to change. So I was honestly surprised when I got a letter saying that Anthem had agreed to pay the bill. Good for them.


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