BCBS Of Florida Only Sends Reader 12% Of What They Owe Him

The good news is that Ander has gotten checks from Blue Cross Blue Shield of Florida. The bad news is that they’re $6265 off the mark of what he should be getting. He has worked with BCBS and the Florida Insurance Commissioner, but neither has been able to successfully make BCBS’ check-sending system match the reality of their financial obligations to Ander…

I’m a long time reader, but I’ve never posted anything. I need help, I’m at the end of my wits. Here’s the down-low:

December 10th, 2007 I had a bi-lateral arthroplasty on my jaw for TMJ. This was medically necessary as proven by an MRI and approved beforehand by Blue Cross & Blue Shield of FL. The grand total came to $7125, and since the doctor was a non-participating provider I had to pay in full up front and the doctor’s office would file with Blue Cross & Blue Shield of FL for me to get reimbursed.

A couple weeks later I called up the automated claims line to check the status and it said it was denied, and the human rep I was transferred to said it was for lack of information on the claim. Come to find out, the doctor’s office had submitted it with the office provider number, not the doctor’s number which BC/BS required. It was immediately refilled with the correct number. I called to check on it a couple weeks later to find it was denied AGAIN for the same reason. The info was faxed over again and this time I spoke to Felicia and got a confirmation number that they did actually get the info. Two weeks later it’s the same deal. They never got the info.

Now I’m getting a little frustrated. I called the Insurance Commissioner on 2-19-08 and was working with Debbie. She spoke to the insurance lady at the doctor’s office and we sent Debbie all the information we had: the original claim, the EOBs, everything. Debby sent BC/BS a nice letter stating they had 30 days to remedy the claim. About a month later I got a check in the mail and a letter from Debby saying the claim was resolved! Too bad it was $430 for a claim that was less than half of what it should be. I called back Debby and told her NO, it was NOT resolved. She said there was nothing else she could do and I should speak with my local insurance rep at my work who could file a grievance and appeal.

I decided to call up customer service one more time on 5-5-08. This time I spoke with Stephanie who was very helpful. I told her the whole deal and explained that the claim should be filed with the $7125 amount, not $3100 for a claim that I or the doctor’s office still don’t know what is for. She then did reprocess the claim with the correct amount and correct provider number and furnished me with a reference number. Thursday, 5-15-08, I got another $430 check for the aforementioned mysterious claim.

Today, 5-20-08, I called a lawyer to set up a consultation. I’d really rather just get my claim paid than have to go through all this legal nonsense. Please Consumerist, do you or the venerable hive-mind have any tips, or can find me some addresses I can drop a formidable EECB on? Thanks for any help.

We’ll help you get that EECB started. It looks like the email address format is lastname.firsname@bcbsfl.com, or sometimes just lastname@bcbsfl.com.

Here are some company executives:

Robert I. Lufrano Chairman and CEO
R. Chris Doerr EVP, Chief Administrative Officer, and CFO
Fred Ryder SVP, Corporate Development and Strategy
George W. Foyo [President, Operations, South Florida]
Tony Jenkins [President, Market]
Daryl Veach [Chief Actuary & Vice President]
Jeannette W. Ekh [Chief Information Officer]

How did we figure this out?

1. We googled Blue Cross Blue Shield of Florida.
2. The website is bcbsfl.com
3. We googled *@bcbsfl.com
4. Glancing through several pages of results we saw an email address or two that gave us the company format.
5. BCBSFL’s Google Finance page had some of their high level execs.
6. Googling “Blue Cross Blue Shield Of Florida” gave us some more execs.
7. Now just combine and you’ll have yourself a functional executive email carpet bomb.

(Photo: Getty)