It was with great interest (glee) to read the Statesman story regarding Mr. Smith, his caretaker and Blue Cross. I too have had the response “we are following Medicare guidelines” whenever I questioned the adjudication of my claim. Obviously from the result, there is more than one interpretation or error in use of the guidelines. I must assume that a new claim employee is required to repeat that phrase five times in 60 seconds to move from probationary to permanent employment since it is used by all Blue Cross claim personnel.
Fortunately for Mr. Smith, the State Department of Insurance overrode the “interpretation error.” My claims were relatively minor as compared to Mr. Smith’s, but since most of us do not have access to the “guidelines,” we are at the mercy of the gorilla in the marketplace.
Seniors have the opportunity to change insurance carriers once a year (which I did for lower premiums and, so far, better coverage), so maybe the little guy might win in the long run as the population ages and Blue Cross feels more pressure to stop squeezing its insured to keep them.
Keith L. Gregory, Meridian