Blue Cross Blue Shield’s Network E Policy May Not Live Up To Expectations

In 2014, Americans were required by the federal government to have health insurance under the Affordable Healthcare Act. Thousands of Tennesseans purchased their health insurance plans through the federal government’s marketplace, but some are finding that their policies are not what they thought they would be. One plan in particular that is causing disappointment in Tennessee is Blue Cross Blue Shield’s Network E.

The Blue Cross Blue Shield Network E plan was popular because it is the least costly. The plan is geared toward people who need affordable health insurance coverage. Many people who purchased the Network E plan never had health insurance before, and the new Blue Cross Blue Shield plan allowed them to buy it at a reasonable cost. So far so good, but problems have been presenting themselves over the past 8 months that make Network E less than desirable.

After purchasing their plans, people began to make appointments with healthcare providers they believed were within their networks. In reality, these physicians were not members of the Network E plan although they believed that they were. When these doctors billed the insurance company, their claims were denied. The result is that the unsuspecting patients are responsible for these medical bills.

Blue Cross Blue Shield sold the Network E plan to Tennessee residents and gave them a book, along with their policy, containing the names of healthcare providers who would take the insurance. Many of these providers did not accept Blue Cross Blue Shield, but their names were still in the patients’ books. Because they didn’t realize that Network E did not include the doctors they wanted, thousands of consumers have switched from the Network E plan to more inclusive and more expensive plans. Hundreds of people have called the Tennessee Department of Commerce and Insurance to complain that they would be unable to see the doctors they thought they would be able to see on the Network E plan. Others complained that if they needed to see a specialist, they would have to drive a prohibitive long distance to get see one.

People in the insurance industry are blaming the consumers for their disappointment! Health experts suggested that first-time buyers weren’t sophisticated enough to research who would be in the network before buying their plans and they only made their decisions based on the price. They also blamed the federal government’s marketplace website for some of the confusion. However, this finger-pointing doesn’t help those who were negatively affected by Network E. Even physicians who are familiar with the insurance industry were confused by Network E. These healthcare providers knew they accepted Blue Cross Blue Shield, so they believed that they accepted Network E plans. They discovered differently only after their patients’ claims were denied by the insurance company.

It was not clear to first-time buyers, knowledgeable consumers, or even healthcare providers, which doctors and medical professionals were participating in Network E. Tennesseans did not learn that the doctors they thought were in the network couldn’t accept their plans until after their claims were denied. This has saddled thousands of people with medical bills they didn’t expect to have to pay. Blue Cross Vice-President Roy Vaughn insists that his company “works very hard to educate clients about the intricacies of all of their insurance plans”. If this is the case, they seem to have failed miserably where Network E is concerned.

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