Blue Cross dogged by delays in processing some NC claims

05/06/2014 6:13 PM

05/06/2014 11:53 PM

Software glitches have delayed tens of thousands of insurance payments from Blue Cross and Blue Shield, but are expected to be resolved by the end of May, ending six months of frustration for doctors and patients.

Blue Cross, North Carolina’s largest health insurer, blamed the chronic delays on the botched roll-out of the Affordable Care Act as well as system bugs in a new claims-processing computer system that the insurer installed last year. The backlogs, some lagging for several months, piled up when patients and doctors resubmitted their claims, said Blue Cross spokeswoman Michelle Douglas.

Blue Cross spent $220 million on infrastructure and technology last year as health care computer systems escalate in cost and complexity, sometimes exacerbating the inefficiencies they are designed to solve.

The company enlisted contractors, and staff worked overtime and even overnight to get claims through the system, Douglas said. Blue Cross delays in recent months have been more than twice as high as usual, with nearly 20 percent of claims taking more than a week to process, prompting online status updates to keep customers apprised of the company’s progress.

“We continue to take an aggressive approach to reducing claims inventory that is outside of our historical processing timeframes,” said a message to customers sent Monday. “Please do not submit duplicate claims, as they increase our inventory and impact our timeliness in processing your claims.”

Complaints to the N.C. Department of Insurance have been rolling in from various medical practices, including the Bone and Joint Surgery Clinic in Raleigh; Mann Ear, Nose and Throat Clinic in Cary; Eastern Regional Surgical Center in Wilson; and Coastal Oral & Maxillofiacial Surgery in New Bern.

Karen Carlton of Raleigh is still waiting for a $200 reimbursement for a pair of eyeglasses she bought in December.

“I’ve been working part time for six months and pay them almost $600 a month for insurance,” Carlton said. “I don’t have the option of saying to them, ‘I had a little technical issue here and I’ll pay you in six months.’ They would cut me off.”

The Chapel Hill-based insurer is paying 18 percent interest on “clean” claims that are delayed more than 30 days, Douglas said. She noted that at all times the majority of claims were processed promptly.

“Even in the worst hour of the worst day over 80 percent of claims were processing automatically in about seven days,” Douglas said. “Now we are back up to 92 percent, which is our historic level.”

Insurance Department spokeswoman Kerry Hall said the agency received about two dozen complaints in recent months.

Janice Arrowood of Hickory said Blue Cross took 4 1/2 months to pay $76.80 for her physical therapy to Catawba Valley Medical Center. The claim was filed in December and not paid until April, so Arrowood took initiative.

“I went ahead and paid it because I was beginning to see that they weren’t processing it,” Arrowood said.

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