Letter to the editor: Not satisfied with Bright Health claim processing | SummitDaily.com

Letter to the editor: Not satisfied with Bright Health claim processing

Amy Simper

I have had Bright Health coverage for three years, the last two under the Peak Health Alliance plan. I have not had satisfactory claim processing with Bright Health. In 2020, my premiums dropped from near $900 per month to the mid $600s for a bronze-level $6,850 deductible policy. This is the cost of being self-employed and having income above poverty level. Any other insurance company would cost about $300 per month more and have fewer options for providers in Summit County.

Though all providers have a photocopy of my 2020 and 2021 insurance cards, Bright Health for the past two years has made errors in billing my nonexistent 2019 policy instead of my current policy. Claims come back with statements like, “denied, coverage not in effect.” Then I get billed for the balance from the numerous providers. Many providers, like the ones for my recent cataract surgeries, required prepayments. Others are still waiting for Bright Health to correct errors. I have paid more than my deductible and am receiving late notice bills from other providers because Bright Health has not untangled the mess in over four months. Of the recent 15 explanations of benefits I received from Bright Health, 10 had errors denying coverage with three stemming from preapproved procedures! I’m being instructed to pay the bills, then get refunds when Bright Health gets around to reconciling my coverage. From a knee injury in January 2020, it took 15 months for Bright Health to straighten out the claims.

Certainly, there are expenses for premiums, the deductible, prescriptions and non-covered items. With Bright Health, clients and providers experience additional costs, including time and headaches. If Bright Health has triple the clients than previous years, then it should upgrade computer systems and hire additional people to correctly process claims from the onset.

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