Mastodawn

Jonathan Kamens 86 47 Aug 5, 2025

Remember my post last week about my insurance company screwing up and refusing to pay for my kid's therapy claims, and it taking me weeks to get to the bottom of it and get someone at the insurance company to acknowledge the problem and claim to be working on fixing it?
It's now much worse. Eight days later they still haven't fixed it, and my kid's major elective surgery scheduled for later this week is about to be canceled as a result.
Details: https://blog.kamens.us/2025/07/28/todays-edition-of-there-are-no-good-health-insurance-companies/#updateaug5
#healthInsurance #fml

Today’s edition of There Are No Good Health Insurance Companies

My insurance company screwed something up, and after many online messages, letters, and phone calls, it’s still not 100% certain that it’s resolved, and even if it is it’s going t…

Something better to do

Last update for the day about this #healthInsurance debacle.
The insurance co. now claims that they have "temporarily" fixed the problem so the surgeon's pre-authorization will go through tomorrow.
Until they find the root cause, the bad insurance info could get added back to Kid's record at any time. We asked if that could happen overnight tonight, breaking the pre-auth again, and they said it wouldn't but couldn't explain why.
What a pain in the ass.
Full story: https://blog.kamens.us/2025/07/28/todays-edition-of-there-are-no-good-health-insurance-companies/#updateaug5

Today’s edition of There Are No Good Health Insurance Companies

My insurance company screwed something up, and after many online messages, letters, and phone calls, it’s still not 100% certain that it’s resolved, and even if it is it’s going t…

Something better to do

Kid's surgeon's office has made it clear this morning that they are exasperated dealing with Kid and their insurance problem and would rather make their own jobs easier by canceling their surgery than do their jobs and work with the insurance company to resolve the billing problem.
If they cancel the surgery then it will end up being rescheduled for the middle of the semester, which means Kid will have to withdraw and miss a semester of school.
Y'all, this sucks.
#healthInsurance #fml

And… Kid's surgery has been canceled.
The doctor's office supposedly spent an hour on the phone with the insurance company, during which all the insurance company was willing to commit to was, "Well, we _think_ it's fixed, but we won't know for certain for 72 hours, and we can't put anything in writing until then," and of course 72 hours from now is past the surgery date.

The most infuriating thing about this is that even if it were true—which it isn't!—that Kid had other primary insurance, the surgeon wouldn't need to worry about getting paid, because they could simply submit the bill for the surgery to the primary insurance, and then submit whatever portion of it didn't get paid to the secondary insurance.
But apparently that would be too much work, so they can't be bothered.

Kid's entire life has just been upended for the next six months because of the completely dysfunctional and broken U.S. healthcare system.

As I just wrote on my blog:

All this grief and chaos has been caused by a shitty insurance company with shitty computer programs which made shitty errors which they shittily failed to detect themselves and then shittily failed to fix in a timely fashion, which is all part and parcel of the shitty, late-stage-capitalist, collapsing-in-real-time healthcare system in the United States.
#healthCare #healthInsurance
Ref: https://blog.kamens.us/2025/07/28/todays-edition-of-there-are-no-good-health-insurance-companies/#updateaug6

Today’s edition of There Are No Good Health Insurance Companies

My insurance company screwed something up, and after many online messages, letters, and phone calls, it’s still not 100% certain that it’s resolved, and even if it is it’s going t…

Something better to do

Wow, what a roller-coaster ride.
The surgery may be back on.
My company's heroic HR rep managed to convince Blue Shield to issue a written letter confirming they are the primary insurer for Kid.
Letter in hand, Kid went back to the surgeon's office and asked if they would proceed with the surgery.
They said yes if we sign a waiver agreeing to pay if the insurance doesn't.
We said yes, despite the risk, because what else could we do?
#healthInsurance #healthCare
Ref: https://blog.kamens.us/2025/07/28/todays-edition-of-there-are-no-good-health-insurance-companies/#updateaug6b

Jonathan Kamens 86 47

Update on this:
* Kid's surgery went ahead as scheduled on Friday. Yay! The surgery went well. Kid is recovering rapidly.
* #BlueShieldOfCA has four different claims for Kid which were processed incorrectly because of the mistaken "other primary insurer" in their computer. I had to call today and ask them to reprocess those claims, of course it did not happen automatically. It could take up to 45 days to reprocess the claims.
(continued)
#healthInsurance #fail

Jonathan Kamens 86 47 Aug 12, 2025

* I found out today that the insurance for my other two kids on our policy is screwed up in exactly the same way, and each of them has multiple claims that were processed incorrectly as a result. I'm probably going to have to hound the insurance company for months to get them fixed. In the meantime all these providers are going to be sending us bills because the insurance company refused their claims. 😡
#BlueShieldOfCA #HealthInsurance #fail

Here's an update on the #healthInsurance saga I've posted about before, wherein #BlueShieldOfCA has rejected claims and nearly caused scheduled surgeries to be cancelled because they've hallucinated my kids having Aetna health insurance that they don't have.
They're currently sitting on over $4,000 in claims for my kids' care they're refusing to pay because of the nonexistent Aetna insurance.
…

You might think the way to fix this would be for Blue Shield to call Aetna, confirm that my kids don't have coverage there, and remove the bogus data to that effect from their database.
After all, this is Blue Shield's error, so it would seem to be Blue Shield's responsibility to do the leg-work to get it fixed, right?
Instead, yesterday they told my HR rep that it "might" help if I got Aetna to send me a letter, for me to pass on to Blue Shield, confirming when my coverage with them ended.
…

But MY KIDS HAVE NEVER HAD AETNA INSURANCE. They did once have GEHA insurance with Aetna as its claims network and processor. However, because we never directly had coverage through Aetna, the best I can do is ask GEHA to send me their standard proof of coverage letter showing when our coverage with them ended, but that letter won't mention Aetna.
Blue Shield is asking me to provide evidence that doesn't exist to, impossibly, prove a negative, i.e., that we DON'T have the insurance they claim.
…

Keep in mind that they've already fixed this problem for one of my kids, without requiring us to get a letter from Aetna. And yet they are refusing to do for my other two kids what they did for the first one. While doing that they're leaving us on the hook for more than $4,000 in medical bills.
Incidentally, if I were really trying to commit insurance fraud or whatever, then wouldn't I simply forge the letter they're asking me to get?
This is a big, steaming pile of performative bullshit.

Jonathan Kamens 86 47 Sep 25

OK, so, remember how #BlueShieldOfCA was falsely claiming that my kids had other primary insurance and rejecting thousands of $$ in claims?
Today they claim it's "fixed", but rather than reprocessing all the broken claims, they told me to contact the providers and have them resubmit.
That shouldn't be necessary, AND it won't even work.
It's like they're doing everything they can to avoid paying claims. Wait, that's exactly what it is.
More details here: https://blog.kamens.us/2025/07/28/todays-edition-of-there-are-no-good-health-insurance-companies/#sep25update
#healthInsurance

Jonathan Kamens 86 47 Oct 21

I spent another 40 minutes on the phone today with #BlueShieldOfCA trying to get them to reprocess the seven claims that are still broken. Will they do it this time? Your guess is as good as mine.
Everything about this was their fault. They could have chosen at any time to fix the errors without prodding from me or my HR rep.
The purpose of a system is what it does. What this system does is make it harder for people to get their claims paid.
More details: https://blog.kamens.us/2025/07/28/todays-edition-of-there-are-no-good-health-insurance-companies/#oct21update
#healthInsurance

Matt Zagaja Oct 21

@jik I am not your lawyer but personally my advice at this point send their registered agent (lookup on Sec of State website) a 93a 30 day demand letter.Hell use ChatGPT to turn your blog post into the letter and edit it. While often viewed as an escalation the legal department tends to have greater flexibility in resolving things across internal systems. https://www.mass.gov/info-details/30-day-demand-letter