Health Insurer Admits “Mistake” – and Still Sticks Disabled Veteran With $110,000 in Medical Bills
Here's the good news: I used money raised from this newsletter's paid subscribers to hire a patient advocate to come to the rescue.
EDITOR’S NOTE:
Before you get into this piece, originally published in Marshall Allen’s Allen Health Academy newsletter, I would like to give a brief introduction to Allen and the incredible work he does to help patients, employers and even a former health insurance executive like me, when it comes to navigating the convoluted U.S. health care system.
Allen is the founder of Allen Health Academy, author of “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win” and an investigative journalist with a decade-long stint at ProPublica.
I encourage you all to follow Allen’s work and subscribe to his newsletter.
- Wendell Potter
When companies make a mistake, they’re supposed to own it and make things right for the customer.
When Blue Cross Blue Shield of Illinois made a big mistake, they stuck a disabled veteran with more than $110,000 in medical bills.
Brian Ridzy, 48, is a disabled veteran living in Brunswick, Ohio. He served as an aviation mechanic in the Navy and spent time in the Middle East, where he was exposed to toxins that led to Gulf War Syndrome, which causes a host of autoimmune diseases. He also battles PTSD, anxiety, depression, memory lapses and other ailments.
In 2018, Brian obtained 18 months of insurance coverage through BCBS of IL in a divorce settlement. Brian already had health insurance through Tricare, the coverage for people in the military, but it became his secondary policy when he added the BCBS of IL coverage. It made sense to pick up the BCBS of IL because it improved his coverage.
Things ran smoothly with BCBS of IL, but then, somehow, the insurer made a big mistake. Brian’s coverage ran out in 2019 but the insurer kept renewing his plan. Brian didn’t notice because BCBS of IL continued pre-approving medical care, paying his medical bills and sending him EOBs.
BCBS of IL stopped paying Brian’s medical bills in February 2023. But it didn’t just stop. It retracted its payments for all his medical providers going back to 2019. It clawed back hundreds of payments – leaving him on the hook for the bills.
Insurance company: “People make mistakes…”
BCBS of IL didn’t even notify Brian – he got the alarming news from his chiropractor. If the insurer had notified Brian when his 18 months of coverage expired, he could have made Tricare his primary insurance, so it would have paid the costs.
Brian had to call BCBS of IL to sort things out. He recorded the February 2023 calls and shared the recordings with me. The customer service representatives were friendly on the phone, but couldn’t explain why the company had made the mistake of continuing to pay his bills for so many years. They made it clear that he could become responsible for the payments. If the coverage expired in 2019, a representative named Kendy told Brian, “then anything after 2019 you would be responsible for.”
“People make mistakes,” Kendy continued during the February 2, 2023 phone call, sounding empathetic but powerless. “We’re all human, and unfortunately some of us are caught in the middle of those mistakes.”
Four days later, Brian asked Charles, a different BCBS rep, why he should foot the bill because of the company’s mistake.
“If I screw up, I own up to it and my company takes care of the customer,” Brian said. “In my case it looks like…Blue Cross screwed up, and I’m going to get the consequences of it.”
“Unfortunately, that’s a possibility,” Charles replied.
The next day, Kendy told Brian that his case had been passed along to the higher ups. “What they’re trying to figure out now is do we deny all these claims or do we just let them stand,” Kendy told Brian.
Brian told me that’s the last time he heard from BCBS of IL. After that he started getting buried in hundreds of medical bills.
BCBS of IL has the resources to own its mistake
Let’s put this difficult choice BCBS of IL faced into perspective. It could have absorbed the cost of its mistake, or it could have clawed back its payments and left Brian with the bills.
On one side you have BCBS of IL, which is part of Health Care Services Corporation, one of the largest health insurance companies in the nation, with $1.5 billion in net income in 2022.
On the other side you have a disabled veteran who’s unable to work and survives on a $2,200 monthly disability check from the Veterans Administration.
Here are HCSC’s purported values, as listed in its annual report:
Integrity – “Always do the right thing in the right way, even when no one is watching.”
Commitment – “Act with our members in mind.”
Caring – “Think about how our actions and work impact others.”
The insurer did not treat Brian according to its values. This, sadly, is common. I wrote in Never Pay the First Bill that we need to stop listening to what these health care giants say, and look at what they do. Ignore their marketing slogans and look at their actions.
BCBS of IL did not have to claw back its money and stick Brian with the bills.
I understand the cold logic behind the move, but object to its cruelty. It’s yet another example of the heartless nature of American health care, where caring for the patient is often a mere marketing slogan.
But here’s what I don’t understand. Why didn’t BCBS of IL help Brian get his coverage transferred to Tricare? No one from the company helped him – that’s what gets me.
Brian agreed to waive his HIPAA privacy rights so that the insurer could speak to me for this story. I emailed their media team and a representative replied: “We cannot comment on individual cases.”
“You actually *can* comment on individual cases,” I responded. “This patient was willing to waive his HIPAA rights so that you could speak to me. I will report that you have *declined* to comment.”
The BCBS of IL representative also said the company would reach out to Brian to address any concerns. Brian said he has not yet heard from them.
This newsletter’s paid subscribers helped Brian
It’s either random chance or God’s providence that got me connected to Brian. As you may know, I’m a born again Christian, so I believe God is at work around us. Feeling despondent about the medical bills, Brian went to church in March 2023. He told a man at church – he can’t recall his name – about his plight and that guy connected him with Jerry Ashton. Jerry Ashton, who I quote in my book, is the founder of RIP Medical Debt. I’m proud to partner with Jerry on his latest campaign – to help veterans through his new venture, End Veteran Debt. Jerry got me connected with Brian. Brian doesn’t consider it random chance that he and I got connected.
“God has a reason for everything, and puts people together for reasons, to show us hope” Brian said.
This newsletter is free, but I invite people to become paid subscribers, and then use the money to provide scholarships for my health literacy videos and to hire professional patient advocates to help people snarled in these medical billing nightmares. It’s been a delight to use the money to help a number of people in need.
One advocate we hired saved a patient $224,000 in medical bills. Another saved a patient more than $42,000 after her insurance company denied 273 claims at once. Another helped a man who was Down Bad and Buried in Medical Bills get hundreds of thousands of dollars in expenses covered. And in a bittersweet victory we helped save a family $87,805.
All that work has been funded by the paid subscribers of this newsletter. Thank you! Want to take part in something bigger than yourself? Join us now as a paid subscriber! We are just getting started!
Marilyn Whitley got on the case
I hired Marilyn Whitley to help Brian and she dug in. She said BCBS of IL wasn’t any help when it came to sorting out the problem. “They pretty much just walked away and said ‘You’re on your own,’” Marilyn said of the insurance company. “It’s heartbreaking. He is a veteran. He served our country and we don’t do a good job taking care of our own.”
Marilyn said the situation was overwhelming. With Brian’s physical disabilities and PTSD there’s no way he could have sorted through the insurance and medical billing red tape himself.
Fortunately, when Marilyn made Tricare his primary insurance, she convinced Tricare to backdate his coverage to the time he got cut off by BCBS of IL. Even now, a year later, he’s still getting medical bills and collections notices. But now he knows to have the medical providers route the bills to Tricare so they can be covered. The retracted bills paid by Tricare have totaled $110,000 and counting, Brian said.
“If it wasn’t for you and the paid subscribers of the newsletter, he would be in collections for all that money,” Marilyn told me.
Brian said Marilyn has been a lifeline for him, and he’s incredibly grateful for the paid subscribers of this newsletter for providing the funds to help him. “I can’t thank you enough for everything,” he said. “I feel blessed for meeting you, and Marilyn and Jerry.”
I’m grateful, too! My book and health literacy videos and chatbot are great tools to protect people from the predatory aspects of the health care system. But sometimes people need a professional advocate to help ease the burden.
If you know of other patients in need. Send them my way and let’s see if we can get them the help that they need!
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I'm surprised (and pleased) that Tricare agreed to pay the claims that were resubmitted with them as primary. There is usually some sort of 'timely filing' rule that applies even when trying to re-process mistakes from other insurance companies. It is good that this veteran had someone to fight for his rights. All too often, I see the insurance companies taking advantage of the patient and their lack of experience.
In NY, insurance companies have 2 years to demand payments back from providers. We get those requests constantly usually with little to no explanation even when we have pre-authorized ahead of time. If we refuse to repay the insurance, they withhold future payments from future claims of other patients.
People just don't realize that even when their insurance bills are paid by the insurance company, there is essentially a years long waiting period whereby the insurance can demand the money back and the patient will be billed by the provider. Absolute scam.