BlueCross BlueShield Of Tennessee-CHI Memorial's Agreement Doesn't Help Me

  • Friday, June 21, 2024

The recent impasse between CHI Memorial and BlueCross Blue Shield of Tennessee over insurance billing is not fair to patients. My wife and I have been Memorial patients for over a quarter-century and the suggestion by BCBSTN to consider changing to using their new in-network doctors is a non-starter, we are happy with our doctors. While I am still affected since I am a Blue Advantage member, my wife is not yet Medicare eligible and is stuck in the soon to expire BCBSTN S option. A contract should never end in the middle of a calendar year when there is insufficient time to switch insurance plans prior to upcoming medical appointments or procedures.

We went through similar nonsense when we had insurance through my wife’s employer a number of years ago. One fall, her employer, the State of Georgia, reached an impasse with our insurance provider that was not settled until the very day that insurance changes had to be submitted. That caused us to change insurance plans, since neither one of us could take time from work to be sure our old insurance was still in network or if we needed to choose an new plan.

Within a couple of years, the state of Georgia went from offering several insurance plans to only one, the grossly incompetent BlueCross BlueShield of Georgia. I personally experienced repeated foul ups with their handling of my claims and their inability to hire people who were properly trained to handle complaints on the phone added to my misery. At that time, we switched to my employer’s BCBSTN plan, which has been completely professional in their handling of our claims for over a decade.

I am currently trying to find replacement insurance for my wife at the last minute, since the agreement ends June 30. It isn’t easy trying to get sufficient information on line and calls are not being returned from people who could help. Either BCBSTN and CHI Memorial will settle their differences soon or BCBSTN will not only lose her business, I will dump my BlueAdvantage program for another insurer at the end of this year.

We are not alone in our criticism of BlueCross BlueShield of Tennessee’s short-sighted, hardball negotiations with CHI Memorial. Hopefully, their executives will wake up and solve this avoidable problem.

I have since learned that the loss of a preferred in-network provider mid-year is not considered a significant event in order to be able to change insurance providers. So if no settlement is reached, we end up paying premiums for nearly useless out of network coverage, or else my wife will be forced to give up her long time physician. 

 

This is no way to run an insurance company, I doubt that this impasse would have occurred under the late Roy McDonald's tenure as BCBSTN chairman of the board.

Ken Dryden

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