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Blue bureaucracy

Written by Rosa Colucci on .

It was with much interest that I read the July 18 story about the current investigation into the "Blues" ("State to Probe Blue Cross, Blue Shield Insurance"). Something else the state should investigate is the inability of Highmark's claims department to differentiate between a foot and a shoulder when it comes to workers compensation claims.

In 2006 I injured my shoulder at work and filed a workers compensation claim for medical coverage. Three years later, May 2009, I had a medical issue with my foot, totally separate from the previous injury. Because both of those parts of my body had "swelling" and the claim contained the "swelling" billing code, Highmark bounced two doctor's visits.

After spending inordinate amounts of time on the phone with their member service representatives, it was ascertained that since the "swelling" code was present on both medical conditions, even though three years apart and on different parts of the body, Highmark's computers or representatives denied the claim.

Furthermore, in the future, if any illness or injury involves swelling, that claim would also be denied. To resolve these problems, my husband and I spent much time on the phone with Highmark giving explanations.

While my situation is now resolved, how many thousands of Highmark's and "Blues" subscribers have gone, will go or are going through the same situation? It seems along with the current issues being investigated, that the Blues' desire not to pay any claim that they can avoid needs to be addressed.

JANICE GRUMET
Squirrel Hill

 

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