Health Insurance Reimbursements: Be Prepared to Wait
Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog- Health Insurance Reimbursements: Be Prepared to Wait. In Beyond Primary Care blogs we highlight healthcare news, advice for medical conditions, and how membership for care works! Beyond Primary Care is an insurance free, membership based family medicine clinic. Beyond Primary Care is the highest rated Direct Primary Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne counties giving families and employers peace of mind about healthcare costs by providing affordable and accessible primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions we receive from patients that we believe are important. We want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, we want to educate our patients and any prospective patients about: Health Insurance Reimbursements.
Introduction to Ogden
This is Ogden, he is the fun & brave boy of Dr O’Boyle. As part of his healthcare, my wife and myself bring him to a family doctor for his routine wellness exams. His family doctor does an amazing job. We do choose to vaccinate but one thing the primary care office does not offer is childhood pediatric vaccines.
Stocking A Vaccine
For those that don’t know, stocking any vaccine is a costly endeavor for any medical clinic or pharmacy. Most offices break even at best but many also lose money on vaccines. Vaccines are not sold by a single shot. Often, they are sold in packages of at least 10 and have expiration dates within a year. Unless you are a part of a medical clinic where there are a large group of people getting vaccines, a clinic or pharmacy stocking every single vaccine is not feasible. Not to mention storage and monitoring requirements of all these vaccines, which is not inexpensive either.
Our Vaccine Solution
Once a year or more, we bring Ogden to our county health department for the shots. The county health department stocks all the vaccines we have needed and at least once a week has a nurse available to administer the vaccines. Like any parent with a child being given a vaccine, this time involves lots of hugging and soothing.
Health Insurance Reimbursement
My wife and myself carry a high deductible health plan with Blue Cross Blue Shield. We are both pretty healthy, and being in the business of healthcare has taught me paying cash for most things in healthcare is more affordable than going through insurance. Still, vaccines are a fully covered service under the Affordable Care Act, so why not use it, right?.
The county health department is smart though. They don’t accept any insurances, saving themselves the administrative headaches. Instead, they will give you what’s called a ‘superbill’ to go along with the receipt, that details the appropriate coding language insurance companies seemingly can only understand. If you can draw yourself away from Ogden’s smile above for a second you can see those documents attached here.
If you look at the receipt, you can see I spent a good amount of money on Ogden’s one year vaccines, over $700. My wife took the receipt, the ‘superbill,’ and completed the reimbursement page and sent this to Blue Cross on 11/11/2021.
The Phone Call
Fast forward, March 2022. No reimbursement yet from Blue Cross Blue Shield. No decisions. No acknowledgement. I took initiative exactly 4 months after we submitted this to contact Blue Cross Blue Shield.
Have any ever tried calling these people before?
For bringing in record profits nearly every year off your and my premiums, you would think they could hire some more customer service agents. After getting through the identification automation part of the call, I was informed my wait time was between 22 and 39 minutes. One hour and 25 minutes later I finally got through to an agent.
Where’s that Reimbursement? The Wait Starts
What did I find out? They had received the information. Everything was correct. There were no errors. Blue Cross Blue Shield had simply neglected to submit the reimbursement to claims, and now I am subject to wait another 30 days. Potentially five months in total. Let me repeat this, FIVE MONTHS- could of been longer, if ever- had I not called.
Health Insurance: A Broken System
If anyone wants to know why the health insurance system in America is so irreparably broken, look no further than how it reimburses it’s own members- let alone the thousands of physicians, pharmacists, therapists, and others who bill for the services they provide.
Imagine having Netflix and deciding to withhold payment for five months. Going to stream that hit series? Nope. Imagine owning a restaurant or brewery and payments from customers may take up to 5 months to receive, only if you have a dedicated employee who can track down reimbursements. Again- not happening.
Yet, this is what happens everyday when people use their ‘great health insurance’ and professionals out there are operating in good faith that the insurance companies will dispense the payments rightly owed.
Great health insurance doesn’t exist.
Health insurance companies use this delay tactic to accumulate money rightfully owed to its members or the professionals in a hope that they eventually give up and the claims are lost. I promise Blue Cross Blue Shield won’t be hunting anyone down to say they owe money.
Will my experience end in a positive way? I sure hope so. I’ll update everyone when I know more.
Thank you for reading.
Dr. Jeff O’Boyle with Beyond Primary Care
