I’m not going to get into the whole messed-up big picture of all that is wrong in the current state of healthcare – just give a micro example of the dysfunction that is endemic.
I live in New York, and I work for a company based in Minnesota. We (between us) pay for a high-deductible Blue Cross / Blue Shield plan. This causes issues every time I use the insurance because the doctors submit the bills to Empire BCBS (NY) even though my card clearly says I have coverage with BCBS of MN. (Exactly the same thing happens with my dental insurance too).
I need to get a CAT scan, and because I’ll be paying the negotiated cost myself as I haven’t hit my deductible for the year ($3200) I would like to have some idea how much that will be. So I call BCBS and talk to a very nice lady in Minnesota. She guides me to a place on the website that should do exactly this (give an estimate of cost). But first I have to put in what kind of plan I have. Apparently I have an “Aware” plan – which is great to know since it is not shown on my card, the webpage, or anywhere else on the paperwork I have (probably buried in the hundreds of pages of stuff they sent me). I put in my zip code and nothing comes back. The nice lady explains that this is because I live out of state and the tool is only designed to work within MN (despite the fact it accepted the NY zip code).
Here’s where it gets laughable. She explains that she can’t tell me what is covered or what it will cost because they don’t have the info. I respond saying they must have the info because they pay the claims. That’s a different department she responds. She realizes this is a crazy situation but BCBS haven’t given her the tools to do anything about this. I explain I just want a ballpark figure – is it $300 or is it $2000? The last time I had CAT scan was 20 years ago and it cost over $10,000 – but that was then. She would really like to hep but she can’t.
Just for the hell of it I type in my old MN zip code and I get costs varying from $350 to $1400 depending on which facility I use. I can use that thousand dollar differential much better than some random health facility so I would still like to get to the bottom of this – as much for the principal at this point.
So I call BCBS of NY (Empire BCBS). It’s a little difficult to find a phone number because the web site just says call the number on your card. When I find a number and call it’s also hard to get through the menu without an account number but I keep selecting random things and pressing zero to get a person. The person who answers is also nice (kudos to BCBS nationwide for that) but she can’t help me either. Can she give me a range of what they reimburse? No. Again she is hamstrung by procedure, but she suggests I call the facility.
I call the facility and speak to the billing department and the lady there is even more helpful. She understands the confusion and is not at all surprised by the lack of communication between the various BCBS entities. What she can tell me, though, is the actual amount that they bill to BCBS ($1090, for the record) so I know that the actual amount I will pay will be lower than that. I’ll update this when I find out what the actual cost to me is.
I’m not at all surprised by the confusion and lack of communication between different insurance entities – and imagine the wasted cost of all these useless middlemen! I am very surprised that a CAT scan in Chelsea, NYC is a fraction of the cost of the same procedure in Minnesota (depending on facility).