Claimant says: "CARE FIRST BLUE CHOICE
I was going to Holy Cross Pain Management at Holy Cross Hospital for several years. Our Health insurance has been through my wife's private sector job which was with Care First Blue Choice the whole time and when she accepted a job with the Federal Government we also stayed with Care First. The lab the clinic used was Alere which is not in network with Care First but at first, Care First had been sending me a check for the lab which I paid Alere with. They told me they were paying it because I ”
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Claimant says: "CARE FIRST BLUE CHOICE
I was going to Holy Cross Pain Management at Holy Cross Hospital for several years. Our Health insurance has been through my wife's private sector job which was with Care First Blue Choice the whole time and when she accepted a job with the Federal Government we also stayed with Care First. The lab the clinic used was Alere which is not in network with Care First but at first, Care First had been sending me a check for the lab which I paid Alere with. They told me they were paying it because I had no way of knowing where the clinic sent my test.
Wanda Lessner @ Care First told me Lab Corp is their only in network provider who they should be using. In March 2014 our policy changed. Because of health cost rising, so we than had a $6000.00 deductible for out of network services. The lab cost was about $400.00 per visit, which is what Care First had been paying. In November 2013, I received a letter stating, because of regulations, the Lab has to move to their own location. Which I had no idea they were sharing the clinics space until then. I knew then if I went to their new location and knowing they were out of network, I would be responsible for paying the lab bill. I called Member Services and asked them what to do and they told me to call or file a complaint with the corporate office, which I did. I first spoke to Sandy Stemmer and she had Wanda Lessner call me to explain the problem. She said she would look into it and told me she will have someone inform Holy Cross Pain management they must send Care First HMO clients to Lab Corp. I spoke to the Doctor at Holy Cross and he said, he is only a contract doctor there and he has tried to get this changed, but said they will not change it no matter what Care First says. I informed Wanda Lessner and she first said she would override the lab bill but then I informed her that my wife is taking a job with the Federal Government. She said there guidelines were more strict and she will have to see if she can override theirs. She said it will take her a week or less and get back to me. Weeks had gone by and Wanda Lessner had not called me back or fixed anything so if I continued going to this lab, I would be responsible for the lab bill up to 6000.00 and once we changed to the Federal Government's plan, that had no out of network benefits.
I called Care First every week to see what, if anything, they were doing. I called Member Services, the president???s office of Care First and was never allowed to speak to Chester Burrell (their President) (410-605-2470). Anytime I called they directed me back to Wanda Lessner in the executive office. (410-528-7142). At first she told me she has had someone inform Holy Cross that they must send me to Lab Corp. Nothing changed over weeks or months, so I tried to call Chester Burrell, the president of Care First, again, but his secretary Sandy Stemmer would not let me speak to him and directed me back to Wanda Lessner. I told Wanda that the clinic refused to send me to Lab Corp but she said they were advised. I told her I advised them but they wont listen, and since Care First has a contract with the clinic, Holy Cross Hospital and the Doctors, since they are all in network, they are supposed to send CareFirst members to in network providers or labs
In August 2014 our policy changed as I told Wanda Lessner it would because my wife accepted a job with the Federal Government and again we chose a high option Care First policy. Now we have no out of network benefits, and if I went to this new lab location, I would be responsible for the lab bills. Holy Cross Hospital Pain Management refused to let me go to Lab Corp even though my Doctor there asked me to find out of Lab Corp could do the same tests. I had to get the test panel from Alere and send it to Lab Corp to see and yes they said it was not a problem. In the meantime Holy Cross Pain Management sent me a certified letter dismissing me as a patient. I continued to call Care First and called their main corporate office Blue Cross Blue Shield but again said my complaint will be sent to Chester Berrell.
Now what Wanda has done is sent out a memo flagging only my account, so now, no matter who I call or contact at Care First, they are told not to talk to me and to write via USPS, email or go through their web mail with any questions I have about my benefits, billing or anything. My contract states that if I have any questions or concerns to call the Member Services number on the back of my card just like anyone and that this cannot be changed verbally. I found this out the other day when I called Member Services phone number on my card to find out my benefit information about a new problem I have to have surgery on. My left shoulder is now in pain with a SLAP Tear, which is a new issue. I need to have surgery on it soon. Since they flagged my account to call Member Services and forcing me to write everything, it is impeding my access to my health insurance benefits, which can put my health at risk. It takes them anywhere from 1 day to answer a question to two weeks and some they do not answer at all. (I am a Senior) so if I had no computer or never knew how to use one like my parents, I would be forced to write a letter via USPS. How Wanda Lessner can single me out of all members with Care First is a breach of their contract, it???s discrimination and she is doing it in retaliation because I filed a claim which I am supposed to do according to our contract.
I was able to speak to a supervisor in customer service. I asked him why this flag was put on my account and he could not tell. I asked if any notes he can see when I had called in show that I ever said anything derogatory etc. and he replied no.
I was told by Dr Ghazal at Pain Management at Holy Cross that others have complained about the same issue. I was also told that Holy Cross is in network and that their contract with Care First states they are only to send people to in network providers. Care First should enforce them to do this or take them out of network. They should fire Wanda Lessner for getting paid and doing nothing as well as retaliating against clients and arbitrarily altering the contract we have with them, which is a breach of contract. This is highly prejudicial and fraudulent, we pay the same as others and it clearly states in my policy, on my membership card and everywhere you read on line that if I have any questions or concerns to call the Member Services number or I can send in a web mail which is my choice. It also states in the contract that this wording cannot be changed verbally which is the parole evidence rule. She has caused me days if not weeks of time from work. She should be responsible for compensating me personally unless she was instructed by Chester Burrell to do this to me and if he was, he should also pay for my loss of work.
This has gone on for months and I have not herd one thing from Mr. Burrell personally and I know for a fact that he is aware of this. If you have a problem with Care First, you can call Wanda Lessner direct number is 410-528-7142. Sandy Stemmer direct number is 410-605-2470 who is supposed to be Chester Burrells secretary, but she will not allow you to speak to Mr. Burrell or even send a message to him. The only thing I have done is called in a complaint for not using Lab Corp. Care First's position is they know they can afford to fight anyone in court and most private attorneys if you call them tell you for them to handle this case could run you 10K, 30K or some have said $60,000.00 and none of this has any guarantee of winning. If you make to much money, you cant get a pro Bono attorney, forget calling the Bar Association or any attorney referral service. If you have any money, you wont if you hire an attorney and Care First knows it. They also know most people do not know how to file in District Court Pro Se. For an issue like this, you yourself can do it if you follow the steps. This can be filed as a breach of contract, or sue for Specific Performance and probably Bad Faith Contract.
I recently sent Care First a web mail stating this was done in bad faith which they could be ordered to pay punitive damages. Because I mentioned this, Care First than replied for the first time with reasons they flagged my account. They only gave me a vague response, by stating they did not like my tone, substance or nature of my calls etc. They did not say I used profanity or disrespected them in any way, which gives them the option of later making up any lies if I have to file in court. If you are having issues with Care First contact Wanda Lessner by writing her at 13215 E. Greenbank Road, Middle River, Baltimore MD 21220 or contact Sandy Stemmer if she does not allow you to speak to Chester Burrell, CareFirst???s President @ 8709 Weitz Manor Lane, Perry Hall MD 21128.
If you have insurance through the Federal Government and need to file a complaint with the OPM Office, you can call Arlean Russell or her supervisor William Stewart at 202-606-3818, but do not expect any help. I also after a week received a reply from the director of OPM Health Care, John O'Brien but through the regular OPM people who did nothing anyway. I also wrote the White House and my Congressman. I must have called 100 different phone numbers at OPM, and they either do not answer, or return a call or if they do pick up say they have nothing to do with the Health Care. OPM should be the poster picture of Government waste*” ...Show less »