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Anthem and BlueCross BlueShield: A “whoopsies,” of sorts

What happens when a clerical error pushes nearly 14K seniors off their plan, and a computer glitch means providers don't get paid for months? Almost nothing, apparently.

In general, making a “whoopsie” is not terribly sinister. We can forgive the occasional mess-up. But for big insurers, when there’s a processing error, it’s a big deal.

Case in point: Remember how a few weeks back we were questioning the very premise of managed care organizations? That private companies are best suited to manage the medical claims of government-run programs like Medicare and Medicaid since they have such substantial scale in running these programs for commercially insured patients? We didn’t buy it then, and we’re not buying it now.

And two stories spanning a thousand miles up I-81 back us up.

In Maine, therapists and healthcare workers have been going without payments from Anthem Blue Cross Blue Shield because the insurer is “experiencing delays.”

According to News Center Maine, a new computer software removed provider IDs from their systems, delaying their pay for months (and months).

The error sounds like a mild one. But one affected provider, therapist Rudy Skowronski, says he hasn’t been properly paid in four months: “I probably will get paid, but I don’t know if it’s a month, a week, a year, whenever Anthem fixes their computer,” the article reports. And Rudy’s been communicating with Anthem ever since, with no resolution in sight, and we all know the hassle of engaging with insurance companies.

Also, per the article, The Maine Bureau of Insurance told him in an e-mail that “many providers” in the state are facing this same problem. Is that supposed to make providers feel better?!

And in Tennessee, one “internal error” caused nearly 14,000 East Tennessee seniors to be dropped off one of BlueCross BlueShield of Tennessee’s Medicare plans.

According to 10 News, if affected members don’t re-enroll in their plans, they’ll be dropped by the end of the year. In order to prevent these seniors from becoming uninsured, Anthem has to contact almost 14,000 seniors and get them to re-enroll before the deadline. We can only imagine the success rate there.

And listen, we’ve all made mistakes. We get it. The issue, though, is that the large size and scale of insurers means even little issues lead to large problems. An error pushes almost 14,000 seniors off their health plans, and a computer glitch means therapists and other healthcare workers don’t get paid for months. Errors like these don’t remain in the computer – these are real people, with real lives, losing their coverage and their paychecks.

Whoops, indeed.

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