Rochester, N.Y. - Tom Belknap received an insurance bill last week for a regular check-up that should have been covered.
He thought it was a mistake until his doctor called.
“This was definitely something you have to pay,” he says recalling that conversation. “It was a $130 dollar bill and the insurance company is refusing it.”
Some insurance customers of Excellus BlueCross BlueShield of Rochester have been overcharged and in some cases have had their claims denied. The company blames an “coding issue” but has no plans to notify members who were affected.
“It’s a huge frustration because you wonder what’s behind it,” says Belknap who is still not sure why his claim was denied.
The problem involves high deductible plans. Customers with those plans have to pay out of pocket for things like medicine and doctor visits, until the deductible is met. After that the insurance company is supposed to pay.
But when those new bills were submitted to Excellus, the computers kicked them back, leaving customers to pay up, face collection or to try to fight.
“It’s not like anyone of us has hours free in a day where we have nothing to do but talk to insurance companies,” says Belknap. “It’s certainly a frustration.”
Jim Redmond is the spokesman for Excellus BCBS in Rochester. He says the coding issue is similar to a computer glitch “that resulted in errors in the calculation of their deductibles.” He goes on to say the company shares “the frustration” because the claims have to be manually reviewed which takes time.
“Those who are owed funds will be paid and their records will be correctly adjusted,” says Redmond.
Yet you won’t find that information on the company’s website. Redmond declined to provide a spokesman on camera to answer specific questions. Affected customers will only be notified if and when they are issued a refund.
Tom Belknap says that amounts to the insurance company saying “trust me.”
“You would hope that they would have more communication if something is happening that is that major,” he says.
As for how major the problem is, Redmond says there are roughly 45,000 customers in the Rochester area with high deductible plans. There is no accurate number of how many are impacted.
A similar glitch is impacting Excellus customers in Syracuse where insurance brokers are calling the problem “widespread” and a “real problem.”
13WHAM News contacted six insurance brokers in the Rochester. Two of the three who responded say the problem here is not widespread. A third is withholding judgment as this plays out.
