Newly Insured Texans Having Problems Navigating Blue Cross Blue Shield Coverage

Categories: Healthcare

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It all stems from a positive thing, really.

Thanks to the Affordable Care Act, more people have health insurance. A lot more. Blue Cross Blue Shield of Texas, the state's largest provider of health and accident insurance, picked up 700,000 subscribers during the ACA's first enrollment period.

In the months since, various local outlets have reported the rapid rise in complaints about BCBSTX filed with the Texas Department of Insurance. Last year, there were 162 complaints lodged against the insurer. This year, through July 11, that number has already more than tripled, to 553 complaints.

The complaints, which you can download in spreadsheet form from the TDI's website, are pretty mundane. Slow responses to customer inquiries are a big issue, as is the initial denial of coverage for procedures and visits that should be covered by a new member's plan. When BCBSTX catches the issues, it has done what it can to fix the problems, but the complaints continue to pile up nonetheless.

According to BCBSTX spokesman Louis Adams, all the issues stem from increased volume. The company's call centers are getting between three and four times as many calls as they did before the ACA. The time of the calls received has gone up as well, to almost twice the previous length.

"You've got people who are asking questions, these are folks who it's not 'what's my deductible,' it's 'what's a deductible.' It's a new process for them; it can be confusing."

Adams says BCBSTX is adding call center employees and increasing hours to meet the demands of those who are unfamiliar with being insured.

"We have so many more people purchasing insurance than ever before, so many of them that have never even had coverage generates lots of questions."


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