So I did my name change 3½ years ago and everything was updated. My health insurance through Horizon Blue Cross Blue Shield of NJ was also updated, but it took them almost a year to propagate through their who computer system or so I thought. I have had numerous claims filled by my health providers and covered including GCS I had this past November. They have paid the claims submitted electronically and everything has shown the correct name for the last 2½ years or more.
I had genital electrolysis last Spring/Summer that is covered by my insurance policy. However, you have to pay out of pocket first and then get reimbursed, but you have to wait until the insurance approved my GCS which they did 3 weeks before my surgery and it was recommended to wait until they paid at least one of the hospital bills from GCS as it required special approval and I could reference the approval number on the claim form.
So after they paid my surgeon and hospital, I filed manually with a form I printed online and submitted my claim with a copy of the invoices with the CPT codes and all. Everything had the correct name. This morning I received an E-MAIL about a new EOB on my account and looked it up and my
deadname was all over the place with the correct subscriber ID on the EOB. Now I know my subscriber ID stayed is the same as before my name change, but obviously, when someone keyed it in, my deadname must have been in there and the person didnt't really read or l look at the invoices or form. Are people that lazy????? So it was denied with the code:
QuoteE280 - THIS CLAIM IS NOT PAID. THE PATIENT'S NAME SUBMITTED ON THIS CLAIM COULD NOT BE IDENTIFIED ON THE SUBSCRIBER'S HEALTH BENEFIT PLAN.
Wow, really?? You think??
So I call up BCBS and the customer service rep did not see my deadname anywhere in the system as she was confused as to where the name came from. She was completely stumped. So she told me to resubmit it and in the place in the form where it says "Name of Patient - (If Patient is the same as the Insured, please skip)" to go ahead and put my name there too even though I shouldn't have to.
So this is why you document and keep copies.
It may have been machine read, no? On some level of access, all your info is still in the system.
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Quote from: Gertrude on January 22, 2018, 07:59:34 PM
It may have been machine read, no? On some level of access, all your info is still in the system.
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I doubt it was fully machine read since the CPT codes were all broken down in 30 min increments. Each invoice said 4 hours and the EOB showed it broken down by each unit as a line item (8 units per invoice.) Maybe the first page had OCR done on it as it's a standardized form but the invoices are not standardized and require human intervention. Somone wasn't paying attention since it has my correct name on the invoices and the name must match the patient which it didn't since they put the wrong name in the patient info on the claim.
Sounds like someone has really crappy data integrity. Great thing to find out about a major insurer. :-X
Do you think it was on purpose? If it was manually entered, it's in the realm of possibilities. I switched to a practice that supposed to service lgbt, specifically gay men as a specialty. I had my first visit and I told the NP I am trans. She seemed a little surprised. She asked if my wife knew. She told me to setup an appointment in 6 months and in the online portal, you pick a range of dates and they get back to you. Never heard back. My wife makes an appointment with the same NP and when she shows up, the NP wasn't there. They told her that she had to reschedule. WTF? They said they contacted her, but neither my wife nor I have records of receiving that call. I put in a complaint with Honor Health, which is the organization and I get a call from a manager. She suggests I go to the office that's a little closer to where I live. The only thing that stuck out to me was that the NP went to a Christian based university. She must work with gay men, why would trans be a problem? My mind gets away with me, but who knows, maybe it was just a mistake, but I do wonder.
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Quote from: Gertrude on January 23, 2018, 07:58:14 AM
Do you think it was on purpose? If it was manually entered, it's in the realm of possibilities.
I don't think it was on purpose. They probably put claims initially in a separate system and after they put in the subscriber number all the names (past and present) from that number show up and they selected the wrong one. My subscriber number has been the same with them since 2006, 8 years before my name change. It could have been my wife's name they picked. I've seen this on other systems like when I go to Microcenter and they pull up my account by phone number, 3 names show up, my wife's and both my deadname and correct name. They just think deadname is another family member at the same address. Probably the same thing here. I just think it was laziness of the data entry person.
Hi Sydney,
That's disconcerting to be sure but technology does have it's quirks and limitations compounded by human interactions. About all you can do is to notify them that they need to make an effort to improve the process. Then pray.
Hugs,
Laurie