Highmark billing problems persist for frustrated members

Insurer says ‘number of issues’ for plans on marketplace fixed

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Elaine Wills Fitzgerald says she sailed through the health insurance marketplace enrollment application last December, successfully signing up for a plan through Highmark without hitting any of the roadblocks or confusion widely reported after the website went live Oct. 1.

It’s the seven months since that have been the problem.

Mrs. Fitzgerald and husband Brian, both self-employed and self-insured, needed to shop for insurance after their existing plan was discontinued because it did not meet federally mandated minimum coverage.

The Peters couple thought they were set after getting online confirmation in late December but then ran into an unexpected complication: For seven months, Highmark has not been able to regularly generate invoices the couple needs to prove they have coverage.

“Every month they say, ‘You should be getting invoices now.’ Seven months and they still haven’t straightened it out,” said Mrs. Fitzgerald. “You’re calling and begging them to take a payment over the phone and they say they can’t. How many people are they doing this to?”

Just because there are no invoices doesn’t mean the Fitzgeralds aren’t paying. She has the credit card statements showing the near-$300 per month charged to their account. But somehow that information didn’t get processed at Highmark so she would have proof of payment.

“I felt like I had no coverage,” she said.

Mrs. Fitzgerald said the Highmark customer representatives always assured her that the coverage would not be canceled. Then, in May, a notice from Highmark arrived noting that payment was denied for a $179.30 bill from a local laboratory for blood work.

The bill would not be paid, according to the explanation of benefits from Highmark, because the coverage had been canceled. At one point, she learned Highmark had posted two payments to the plan the couple used to have and was now closed. Then in June, she said, a manager told her the credit card statement she’d sent to prove she’d paid appeared to be altered.

“That’s what put me over the edge,” said Mrs. Fitzgerald, adding that “I have cried on the phone with them because I am so frustrated.”

Highmark spokesman Aaron Billger on Monday acknowledged there were billing problems for what he said amounted to “dozens” of the 131,093 members signing up for one of the more than 12 Highmark plans offered through the federal health insurance marketplace.

“It is not a widespread issue, but any number of impacted members is unacceptable,” he said.

In addition to delayed invoices, the problems included sending inaccurate cancellation or delinquency notices. Mr. Billger said “it was a number of issues” causing the problems, “ranging from the data that we received from the federal government and at the same time implementing a new billing system.”

Those problems have been addressed and fixed, some as recently as last week, he said. In addition, he added, Highmark has set up a special unit to address billing problems, which members can reach by calling the phone number on the back of their insurance card.

“It is so not fixed. I wish that it was,” countered Mrs. Fitzgerald. “If it was fixed, I would have had an invoice in the mail.”

As proof, she said, she checked her Highmark account online Monday and found more problems. Now, in addition to the denied blood work payment, her account now shows an additional $738 in denied payments for lab work.

“It’s not the federal government. It’s Highmark,” she said. “I just think Highmark is inept in everything they do.”

Steve Twedt: stwedt@post-gazette.com or 412-263-1963.

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