Battling BS--and winning!

After four months, I finally got justice from Blue Shield. One of those minor victories, to be sure--but sometimes fighting with the insurance companies seems like a full-time job!

It all started last year, when I spent three months in the hospital in intensive care. When I emerged, my bedroom at home had been transformed into a sort of ward. Gone was my marital bed, replaced with an electric hospital bed and an inflatable mattress for my wife. There was a pulse-oxymeter monitor, a tube-feeding system, a ventilator, oxygen tanks and an oxygen concentrator, and so forth. All rented.

No fear. I'm all better now. All that's left is the final mopping up--i.e., the bills.

While Blue Shield did a great job of helping with the $1 million-plus hospital charges, my policy has a $2,000 limit on “durable medical equipment.”

Naturally, I passed that threshold in almost no time.

The $2,000 DME limit does, however, have two exceptions: diabetic care and oxygen.

So when almost a year later I amassed a bill from Lifecare Solutions for all that rented equipment totaling more than $8,000, well, even Lifecare asked if I could do anything to get more out of Blue Shield. I was on the case!

My appeals to Blue Shield were denied. Yet in the denials I learned about the $2,000limit and the exception for oxygen. Wait, thought! Some of these charges ARE for oxygen!

I immediately called customer service and pleaded my case. The woman there agreed that I made sense. The charges would be reprocessed. But nothing happened. So I called again. I was told my case had been turned over to someone else, a grievance specialist. I left her countless messages. More time passed. Finally I got hold of the grievance officer, who looked everything up and said that, yes, since I had been promised, and had waited so long already, she would approve reprocessing the claims. Eureka! Or so I thought.

More time passed. I called again to check the status. When I finally got hold of the grievance officer, she absolutely floored me. "We've reconsidered," she said

I asked why.

"The exception is for oxygen. Not oxygen tanks or concentrators, tubes, masks..."

"But that's how oxygen comes," I pointed out. "That's the packaging, basically."

She put me on hold. When she came back, she spoke like a child who had been told by an adult what to say. "We only count the oxygen for refilling the tanks, not the tanks and supplies themselves."

It was too absurd. I knew now what I had to do.

Next stop: the Blue Shield Web site, where I quickly located the name of the president and CEO. I guessed--well, extrapolating from another e-mail address I'd found--how Blue Shield's (or should I call it, BS's?) e-mail address system worked, and sent the head honcho a message. I've become very good at these sorts of messages. I was clear, as brief as possible, and firm. Make that threatening. I said if he did not resolve this to my satisfaction, I would have no choice but to pursue the matter with the appropriate state agency. (Since this was in California, perhaps that wasn't much of a threat.)

The next day came the response. Basically, I was right. The charges for oxygen would be reevaluated promptly.

And you know what? This time, they actually were. My total liability: $00.00

Sometimes we do have victories.