Bill errors, rejected claims after switching plans

After two months of trying to get Independence Blue Cross to correct what seemed like a fairly simple problem, Anthony Goldsmith finally ran out of patience.

On Feb. 25, the Media psychologist filed a formal complaint with the company for billing him for the wrong plan, denying his claims, and threatening to terminate his health insurance.

If anything, Goldsmith's experience with Independence shows that transferring health insurance data, even internally from one plan to another, can be problematic.

"I've talked to a health insurance advocate who said I am not alone" when it comes to problems with Independence, Goldsmith said.

Yvette Bright, an Independence executive vice president who oversees several areas including customer service, agreed that the company "mistakenly applied his payment to his previous silver plan" and had rejected his claims.

"Mr. Goldsmith, in my view, did everything he should have done," Bright said. "We did not appropriately update his record to show that he changed plans, and we kept his silver plan showing that it was his primary coverage."

Goldsmith said that, in the last few weeks, Independence has resolved several issues, including paying some, but not all, of his outstanding doctor bills. He wants everything cleared up before he undergoes surgery in May.

"I told them that I want this straightened out because I have pre-surgical testing," said Goldsmith, 63. "Only two of my recent claim submissions have gone through clean. Everything else has been rejected."

The root of the problem reaches back to last year when Leslie Goldsmith, 61, who carried the couple's health insurance, retired. Knowing that they wouldn't qualify for a subsidy on Healthcare.gov, Anthony Goldsmith logged onto Independence's website and, a few mouse clicks later, purchased Independence's silver-tier Personal Choice PPO.

In December, the couple learned that the premium for the silver plan was going up 15 percent. So Goldsmith logged back onto his Independence account, switched to the higher-deductible Personal Choice PPO Bronze Reserve plan, and paid January's premium with a credit card.

On New Year's Eve, Goldsmith received a bill for January's premium from Independence. Confused, he called the company. The customer-service representative said there was no record of the payment. He sent a copy of his credit-card statement showing the payment.

But from there, things snowballed. Goldsmith started receiving invoices with extra fees - the difference between the premium of his discontinued silver plan and the new bronze policy. Then a January claim for a doctor's visit was denied. According to Goldsmith, it was rejected because a primary insurance plan had to be applied first.

"I had been very clear when I applied for the insurance that there was no other insurance," Goldsmith said.

But according to Independence's records, there was another plan - the silver Personal Choice PPO.

Goldsmith started calling Independence customer service. Representatives would listen and promise to call him back, but never did. On one occasion, Goldsmith said, he identified himself, and the customer-service rep told him that "I was in special treatment" and transferred him to an agent selling health-savings accounts.

"Whenever I asked to speak to a supervisor," Goldsmith said, the customer representative "told me I couldn't."

Bright said team members have been trained to refer customers to a team leader or supervisor, "especially when we see that a member has called for a second time."

Independence's customer-service representatives receive 12 to 15 weeks of training. The 600-member staff handles 20,000 to 30,000 phone calls a day from the company's 200,000 customers with individual plans.

"We have continuous training as we glean information from our members and from listening to calls," said Bright, who listens to calls and often speaks to customers with problems.

Bright said Independence was installing technology that would allow customer-service representatives to see in real time how often a customer has called "so that we can be proactive."

On Feb. 3, however, that system wasn't in place. Goldsmith spent more than an hour on hold before reaching a supervisor. The supervisor promised to look into his situation and called back a few days later saying everything had been rectified.

It wasn't. His March bill still contained the extra fees. After filing his complaint Feb. 25, an appeals specialist contacted Goldsmith, assuring him that everything would be set right. He didn't hear from her again until March 20, three days after another termination letter.

Since then, Bright has listened to all of Goldsmith's calls. She is following his case to ensure that "his account is up to date and in good standing." On Wednesday, she said Independence had "reprocessed his claims and contacted the doctors and hospitals that have reached out to us."

"My plan," she said, "is to give Mr. Goldsmith a call on Monday and review with him all the details that I have been following since this began."

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This article was written in partnership with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.