CareFirst error a worry for many

CONSUMING INTERESTS

August 21, 2007|By DAN THAN DANG

A computer glitch at the state's largest health insurer recently blew Sharon Nobles' life into disarray, leaving her family with overdue medical bills and, at times, vital prescriptions denied at the pharmacy.

And she might not be the only one affected.

CareFirst BlueCross BlueShield officials confirm that even as information technology specialists are working to resolve internal system problems, thousands of its members who participate in consumer-directed health plans (CDHP) could be affected, too.

"I've spent months trying to fix this problem, but I've gotten nowhere," said Nobles, the mother of twin 11-year-old boys who were diagnosed three years ago with Asperger's syndrome, a neurobiological disorder that can produce autistic-like behavior. "At first, I was hysterical," Nobles said. "It's an extra burden that complicates my life."

CareFirst officials are urging CDHP members to review their personal account statements and call their customer service representative about any similar concerns.

For Nobles, who lives in New Windsor in Carroll County, the first signs of trouble surfaced in April - a month after CareFirst's own records available online show that her family had paid its deductible in full.

The way their plan works, the Nobles must pay a $2,400 annual deductible, which is repaid to them by a health reimbursement account set up by her husband's employer. Once the high deductible is met, CareFirst pays for most everything except for co-pays. Such plans work similarly to auto or homeowner's insurance plans.

CDHPs are a fairly new type of benefit package that's growing in popularity among consumers who want more control over how much they spend on health care. In return for a high deductible, consumers pay lower premiums. At CareFirst, the number of people participating in CDHPs has doubled this year to 100,000 members.

Now in the Nobles' case, Sharon Nobles works part time for an assisted-living facility and her husband, Bob Jr., is a home accessories installer. Combined, they make about $60,000 a year.

"The high deductible was killing us, but we managed for the first couple months," Nobles said.

Young Bobby and Brian Nobles' medicines cost about $1,300 a month. So the family met its $2,400 annual deductible by March 8, according to the Nobles' explanation of benefits (EOB), or personal account statement, found on the CareFirst Web site.

But even though the Web site said the deductible was met, the CareFirst system that tracks claims didn't reflect that. So the claim denials started coming.

In April, Nobles discovered that the boys' pediatrician had not been paid. She immediately called CareFirst. CareFirst told her to contact the insurance broker for her husband's employer, who said he would contact CareFirst.

In May, payment was denied to the same pediatrician again. This time, Nobles was informed that CareFirst did not pay for the visit because the deductible had not been met.

CareFirst sent her back to the broker, who told her she needed to deal directly with CareFirst. Nobles said she was on the phone with CareFirst repeatedly for the next couple of months. And while most CareFirst reps or supervisors were fairly helpful, Nobles said, the problem persisted.

The snag was maddening.

Nobles could no longer receive reimbursements from her husband's health reimbursement account because they had collected the limit when they paid the deductible in full. On the other hand, Nobles could not get CareFirst to cover expenses because the company's computers showed that the deductible had not been met.

That left the Nobles footing all the bills.

The predicament reached a crisis level in July when Nobles went to pick up prescriptions for her boys at the pharmacy. Standing in a long line with her sons, who were restless and bouncing off the walls, a stressed-out Nobles was informed that she had to pay full price for the medications.

"I had to leave without the prescriptions because I couldn't afford it," Nobles said. "I just broke down and cried."

By the time Nobles contacted me on Aug. 8, she had spent countless hours on the phone with CareFirst. By this time, CareFirst had begun to acknowledge that the error was likely their fault, but Nobles was told the malfunction could take more than a month to fix.

In the meantime, three of the boys' doctors had yet to be paid and, to fill prescriptions, Nobles had to call CareFirst a day ahead of time to have someone call the pharmacist to authorize payment.

"If I didn't go during business hours and a problem came up with payment at the pharmacist, I'd have to leave without the medication because CareFirst office hours were closed and I couldn't reach anyone to help me," Nobles said.

When I alerted CareFirst to the problem on Aug. 9, the company immediately reviewed the Nobles' file. By Aug. 15, all their difficulties disappeared.

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