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Blue Cross Blue Shield Deductible Problem Complaints Skyrocketing

(credit: KTVT/KTXA) Jason Allen
Jason came to North Texas after working as a reporter for four y...
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NORTH TEXAS (CBSDFW.COM) -Blue Cross Blue Shield of Texas is now quickly reimbursing some customers caught by a computer glitch that left them with unpaid bills for months. The company has not narrowed down how many people were affected though, and agents said thousands may not realize it until later this year.

John Wing said he and one of his employees in Rowlett got a check from Blue Cross, just a day after CBS11 first reported their story. The company was not giving them credit for having paid deductibles for doctors and prescriptions. It left Wing and others with bills from doctors, and medicines sitting unclaimed at pharmacies because computers showed insurance wouldn’t cover them.

Blue Cross fixed what it called a glitch, but said each case would have to now be made whole on an individual basis.

It could be months though, according to insurance agent John Stacy, before some people even know they were affected by the problem.

“The deal is the breadth and scope is completely unknown,” he said.

Stacy sells insurance to small businesses and said he believes nearly 40 of his clients are affected by the problem. He’s pretty sure his own policy is part of the issue. His concern is by the time someone realizes they are affected, they are already receiving bills from a provider.

“Now you’re being asked to float 10-thousand dollar hospital bills for two or three months, and then all is made normal?” he said. “It’s just really hard to make that whole.”

Blue Cross said last week it was working hard to update impacted accounts. A letter obtained by CBS11 that was sent to one customer, said “Due to increased volumes and unprecedented changes with the Affordable Care Act we realize some members have not been able to fill their prescribed medications. We Apologize for any inconvenience this may have caused.”

The company said last week that skyrocketing complaints to the Texas Department of Insurance this year were due in part to a large influx of new customers through the ACA. Complaints now total 385 through last week, more than double the 162 received in all of 2013.

Other companies are also seeing complaints rise. Unitedhealthcare has 226 this year, already more than last year’s total. Cigna has 17, nearly triple its 2013 total.  The latter also attributed the number to more customers, and federal healthcare exchange plans that have a smaller network of approved doctors. Confusion about which doctors are actually participating in the plan, may be contributing to more complaints.

United also is aggressively trying to control costs to out of network doctors, primarily specialists, possibly causing more complaints. In a statement the company said “We constantly strive to deliver satisfactory experiences for members, one important aspect of which is to encourage them to use in-network providers to avoid unnecessary out-of-pocket costs.”

TDI is looking at the individual complaints coming in. The Office of Public Insurance Counsel, which advocates for insurance customers in Texas, did not immediately respond to questions Wednesday about any awareness or involvement in the issue.

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