CareFirst/BlueCross BlueShield is stealing your money and calling it 'reform'
Let me tell you how
vol. 3 issue 42
UPDATE:
Thank you to my readers who alerted me to the class action suit against BlueCross/BlueShield due to their violation of anti-trust laws:
If you want to file a claim or learn more: Here’s the site.
Greetings,
We’re later than usual today, why?
Oh, the irony.
Here’s why.
CareFirst wants you to beware of scammers posing as recruiters for their multimillion dollar nonprofit organization, actually known as the Group Hospitalization and Medical Services, Inc., that licenses the Blue Cross Blue Shield name, and has a history of misrepresenting how much it “gives back” from its nonprofit profits.
Meanwhile, their own scam is on, hot and thick behind the walls that will not be scaled by people like you and me who are the real scam victims.
It’s part of the larger, systematized scam that is American health insurance. No reform is actually possible to our healthcare system because it was designed to suit the people who designed it, not us, not the employees, real or fake.
THE SITUATION
I have been trying to cancel my CareFirst health insurance policy since last month. Hours on the phone, days spent on hold or finding a fax machine. Writing letters, sending emails. At every turn, I am told an excuse as to why it can't be done.
I started the cancellation process, after I found a cheaper policy, one of only two others I could choose from. I had not known I could cancel it before open-enrollment in November, even though I had been calling them since May to tell them I needed out of their overpriced plan. My mistake for not investigating that more thoroughly.
But I learned I could, I was approved, and I was actually happy with my new plan, and can actually afford it.
In brief, per the termination section of my contract, I did as instructed and attempted to cancel in the month prior to the one I no longer wanted to carry it:
But what you are not told in that little itty bit of contractual information is that you will need at least 5 days to get a faxed cancellation through, as though it were 1992 and we all have our fax machines ready to squeal.
Nor are you told that mailing it, and praying it gets there within two weeks, is the other option.
Prevailing upon them to let you use the documents portal like you do for every other document that goes back and forth between you and them is not protocol, and anyway their systems are down. And, as it turns out, their fax machines are down, too.
So finally, after 17 attempts to transmit the necessary documents, and six hours on the phone being as patient as possible, what you are told is that you are responsible for this month’s premium and it will cancel in 30 days, and no, there is nothing they can do about it, and so sorry, we’re understaffed so no supervisors are available to take your call.
The compromise: I will get a call from the Correspondence Department “when it is convenient for them”. I have actually been told this once already, so I will report back to you whether they found a convenient time.
In the meantime, here’s an interesting thing that did happen during my infuriating wasted Friday that tells me a helluva lot about what’s going on behind that wall of “when it’s convenient”.
The customer service rep reading from a script broke out of the assigned role and turned human. She told me her mother is enduring the same doom loop with CIGNA where she, too, is trying to cut through the red tape and abide by rules in the good faith that the insurer will do the same.
And, Mom is being worn down by the strain of it.
THE DECEPTION
Here’s to you Customer Service Lady Mom. I am outraged on behalf of you, me, and anyone who has been demoralized by a system that is willing to put profit before anything else. Anything else, including the mental well-being of its employees, and the blood pressure of its erstwhile customers.
This is how the health insurance system is designed. It is what happens when you allow monopolies and their lobbyists to write the rules.
CareFirst’s employees are being put in situations where they have all the responsibility of handling irate customers -- although I am not a person who is abusive, plenty of people are -- and yet are given zero authority to do anything effective about it.
That not only is this unfair to the customer service reps, and will certainly contribute to their burn out -- it is a cynical game designed to wear you and me down, too. I am the one who is having to fight for them to do the right thing, to abide by their rules, to not let an opaquely written contract and 1992 technology cost me hundreds of dollars for NO SERVICE in return.
If I were a CareFirst employee, I would feel bitter about being put in that situation by my employer, probably on a consistent basis, if this experience is any indication.
But there is more insult to me as a so-called “valued customer”. The script read to me today and all the other times I have called in suggests that the way to settle this situation is to just not pay the current premium I am being billed for, and so let my plan automatically terminate.
In plain English: We advise you to default on a bill you shouldn’t have to pay, and take the risk you won’t be penalized in the future for it.
Except that next time I try to purchase health insurance, there will be a note by my name that I was terminated from a policy for failure to pay it.
Even though that is a lie. A lie CareFirst is willing to perpetuate.
How insulting to me as someone who worked her butt off for 6 months to pay the policy in the first place, and who in the end, had one claim against it. One.
Health insurance in the US is designed to serve the carriers; flaccid enforcement of antitrust law has helped their cause.
In the last decade, we have gone from a fairly competitive marketplace to a market so concentrated that there is no meaningful competition. This allows carriers such as CareFirst, CVS/Aetna, CIGNA/ExRx, to get away with abuse such as what I am enduring: where else am I to go? My lack of choices? They are typical…most health insurance markets have at most, 2 carriers to choose from.
As well, this drop in choices and service has occurred while premiums have continued to rise dramatically.
Or, as the Brookings Institute says, “A firm that dominates a market and faces little competition doesn’t have to lower prices or costs, push for better quality, or focus on innovation.”
Meanwhile, health insurer CEO compensation looks like this:
THE REVEAL
I am working on discovering the compensation of CareFirst CEO Brian Pieninck. I believed it to be $14 million, but cannot confirm this, so I will keep trying.
In the meantime, while CareFirst is warning you to be ware of “fraudsters” posing as their own Human Resources Department, the real fraud is that they market themselves as the company that is “making a difference” while putting their own employees in situations where they bear all of the responsibility and none of the authority. These are the employees who have to end their shift knowing they were unable to help people whom they KNOW are being scammed by their employer.
In their own words, “To create a better healthcare experience, we must transform it. This is our call to action.”
Six hours, 17 faxes, emails, letters and no resolution later, I would say so, CareFirst.
Peace,
Whitney
The health care/insurance system in the United States MUST change! SOON! My family of four includes 2 TIDs n barely survives WITH all the BS “care” and “insurance”; I can’t imagine without it - I’ve tried… like having a job or doing work that’s aligned with my purpose rather than “the best coverage” I can get. B!S! Thanks for your work and your voice, Whitney. Please keep going.
More information on these scammy companies that front themselves with customer service reps who end up peddling lies while the carriers pocket money they didn't earn:
https://wendellpotter.substack.com/p/today-we-are-launching-a-coalition