Dear Help Squad,
I am a 26-year-old graduate student. I’m severely asthmatic and have been enrolled in a Blue Cross Blue Shield of Illinois Medicaid managed care plan since Oct. 1. It originally took four months for my Medicaid application to process and, after three months of coverage, I was involuntarily dropped from my plan. Since Jan. 7, I have been calling every phone number possible and not one person has been able to help.
The Illinois Department of Healthcare and Family Services (the department responsible for providing healthcare coverage to adults and children who qualify for Medicaid) put an alert on my account saying I was enrolled in two insurance programs, and without my knowledge dropped me from my Medicaid managed care plan. However, I was never enrolled in a second program. I called a BCBS appeal line, they admitted their mistake and told me the only thing I could do now was wait until April to re-enroll in a plan.
Due to HFS’s mistake, I lost my BCBSIL coverage, I had to change all of my doctors and medications, I had to pay out-of-pocket for an urgent care visit and I have $1,192 in pending medical charges. Today alone I spent seven hours on the phone (four of them on hold) only to be told there is nothing that can be done.
First, some background on the type of insurance into which Denise was enrolled: The Medicaid managed care plan Denise was approved for is administered by Blue Cross and Blue Shield of Illinois, which serves as a Medicaid managed care organization (MCO) for the delivery of healthcare benefits to low-income individuals in Illinois.
As of Jan. 1, that BCBSIL MCO was rolled into a new statewide Medicaid managed care program called HealthChoice Illinois, which includes BCBSIL and six other health insurance providers. According to Health and Family Services, these seven insurers will now provide healthcare benefits for 80 percent of all Illinois Medicaid beneficiaries.
Presumably there was some systems integration work that occurred when the new statewide HealthChoice Illinois program was created.
I mention this because after I spoke with BCBSIL spokeswoman Colleen Miller, she sent me the following statement: “[Denise] held a Blue Cross and Blue Shield of Illinois individual policy until she canceled that policy effective Sept. 15, 2017. HFS, which determines eligibility for Medicaid plans, indicated to BCBSIL that [Denise] would be enrolled in a BCBSIL-managed Medicaid plan starting Oct. 1, 2017. HFS later notified BCBSIL the enrollment was canceled. Unfortunately, due to timing, [Denise’s] BCBSIL card … had already been sent through our automatic system. Although she was never actually enrolled in a BCBSIL managed care plan in 2017, BCBSIL did cover some of the claims after October 2017. We do not hold the member responsible for those fees and apologize for our role in adding to confusion surrounding this unusual situation.”
Prior to my receiving this clarification from BCBSIL — which, by the way, took approximately three weeks of back and forth among BCBSIL, myself and the Department of Health and Family Services to obtain — I received a statement from HFS spokesman John Hoffman who said, “Department records reflect that when the client attempted to select a managed care plan (MCO) last September, the plan enrollment could not take effect. In verifying her information, it was discovered that she already had a private Blue Cross and Blue Shield of Illinois insurance policy … Records further reflect that this [private policy] was ended on Jan. 12, 2018, when the client contacted the department to report the change in her coverage.”
To which Denise responded, “I have no idea what he’s talking about!”
Even though Denise was never granted coverage under a Medicaid managed care plan, from the time she contacted Help Squad until today, her pending medical charges gradually dropped from $1192 to $0, with a final, unaccounted-for charge of $359 addressed by HFS just moments before this column was filed.
And as of March 1, she is now covered under BCBSIL’s Blue Cross Community Health Plan (BCBSIL’s HealthChoice Illinois managed Medicaid plan).
Said Hoffman in explanation: “[HFS] is committed to working with the client and provider to help ensure Medicaid pays for any outstanding expenses the program is able to cover. We apologize for the inconvenience and are in the process of improving our systems to prevent similar errors in the future.”
Send your questions, complaints, injustices and column ideas to HelpSquad@pioneerlocal .com.
Cathy Cunningham is a freelance columnist.