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Saturday, March 15, 2014

Why is Highmark, my Former Insurance Company, Sending Me a Bill...?

Here in Pittsburgh, PA there has been a long-running battle between two local health insurance providers: UPMC and Highmark.

UPMC is a local university system and Highmark is a classic BlueCross/BlueShield provider.  The battle has raged on for years (see this).

More than two years ago Lexigraph changed insurance plans from Highmark to UPMC in large part because the employees only used UPMC hospitals and medical doctors and because it seemed like Highmark was "after" UPMC to force it to provide Highmark customers access to its health system after some "contract" ran out.

Since the change over we have had little problem with UPMC or its plan.

During these last years Mrs. Wolf would occasionally get weird letters in the USPS mail from Highmark which we dismissed as marketing efforts.

But imagine our surprise when we received the bill for insurance from Highmark below yesterday:

Lexigraph has not used Highmark for more than two years.  We properly terminated our plan as required by Highmark at that time.  We have not solicited them or applied for Highmark insurance since then.  We do not want Highmark insurance.

Yet here is a bill for insurance coverage beginning the last month of 2013 (well, maybe - see below).

If we look inside we see this:

An arrangement of Lexigraph employees that is not current or valid but in fact reflects our arrangement of employees from two and a half years ago.  Note the employees names are provided (B and K in the image) - not something Lexigraph has authorized Highmark to use or have access too.  

(NOTE: It is possible that this letter is not a product of Highmark but in fact some type of fraudulent use of stolen Highmark data about Lexigraph and its employees.  Obviously we cannot know this so for the purposes of this blog it is our opinion that Highmark, because its a large company, has protected our data and that is in fact a bill directly from Highmark to Lexigraph).

Now since I am using this blog to point this out I want to make this perfectly clear:

1) We have not solicited for nor applied for any Highmark insurance in the last two years - period.

2) We have not authorized Highmark to use our employee's names or other information (like former insurance plans they had selected or used, information about vision or dental plans, etc) for any marketing purpose.

3) It is our opinion that this solicitation is a violation of HIPAA and a fraudulent use of Lexigraph's employees personal healthcare information (plans selected by the employee previously).

4) It is our opinion that this use of Lexigraph's information as well as its employees is illegal when used to solicit payment for services not requested or authorized (imagine what would happen to Lexigraph if we attempted to bill Highmark for work not rendered using Highmark data).

There are several other fishy aspects to this bill:

1) It has arrived six weeks after the supposed beginning of the coverage.  No insurance company does this - they all expect payment at the beginning of the policy, i.e., in advance.

2) Some portions of the bill refer to a "coverage period" from 12/01/2013-12/31/2013 and other portions to an "effective date" of 1/1/2014.  Again - no real insurance company would bill you like this unless it was a mistake - a coverage period is a coverage period - not half one month or year and some other month or year.

3) We have received numerous repetitive nasty phone calls as described here from people identifying themselves as "Highmark" (see this).  We do not provide employee or healthcare data about our company over the phone to unsolicited phone callers - yet it would appear that's exactly what Highmark (or whoever is running the linked survey) would like us to do.

4) Highmark identifies itself as "Highmark Blue Cross Blue Shield" - the bill only as "Blue Shield."

5) Had we actually applied for this insurance we would have used the correct configuration of employees and benefits they request - not this two year old bad information.

So my conclusions are either

1) That Highmark's data was stolen.

2) That Highmark is, in my opinion, fraudulently attempting  to get me to pay for something I have not asked for, nor do I want, nor have I used.

3) That Highmark has made some impossible to believe mistake with my company's HIPAA-protected data.

None of these makes me comfortable.

I direct our company's use of outside insurance and handle the applications, manage the benefits, etc.

No one here that I know of could have set this up by mistake nor would anyone but me be authorized to do this.

Give the "" issues this is all the more troubling...

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