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Tribal member insurance concerns

Hello Membership,

I have been having MANY problems with our First Health/Capitol Administrators medical insurance. I have spent hours on the phone with either the health insurance company or with Mercy Hospital or other Doctors within the Network. I have of course contacted Tribal Member Health Benefits to help figure out what is occurring. They do all they can, it has to be so frustrating for them as well. With a carrier I previously had when I was with the Casino, which was Anthem Blue Cross Blue Shield, I never had issues. It has been VERY frustrating for me now that the Tribe has switched insurance carriers. I keep getting letters saying the bill has not been paid as long as four months. I am finding that both parties are not necessarily “communicating”. I called both and the insurance company said they are requesting the records of service from Mercy Hospital and Radiology of Durango and both are saying they have never received a request! Mercy has documentation of a “hard copy” sent to the insurance on May 19, 2015! Then I called the insurance back and forced them to send the letters of request while I was on the phone, he put me on a brief hold, which was 17 minutes later and told me it was taken care of. Hopefully it is. Well, you get letters in the mail stating it has been months an months for non payment of their services, it really begins to concern me. I do NOT need collections coming after me simply because I am truly RESPONSIBLE for payment of my own services. At the end of the day it is one’s medical health insurance company that should be keeping things on track. I am writing to let all of Tribal Membership know that if you are experiencing issues, we need to let our Executive Officers and our Tribal Council know exactly what you are experiencing. If Tribal Council does not know, how can they fix it? They need to know.

Also, I have received two checks from several parties that insurance has paid on, probably over issuance of payment. The checks had my name on them, I could have cashed them but I feel since Tribal Member Health Benefits pays the bills, it really is not mine to keep.

I returned and signed both to Erica so they could be re-deposited back to the Tribe. It felt dishonest to keep the money since I have never had to pay out of pocket for medical bills.

I urge you, please put your issues in writing, otherwise they are not truly “recognized”. I have compared these issues with a few other Tribal Members and they too, are experiencing similar problems. Another thing is, if an out sourced Doctor that your primary care Doctor has referred you to a year or two ago and you are sent a reminder for an annual visit with them. Then if they send you for any additional testing such as an X-Ray, it helps if we notify Tribal Member Health Benefits office so they can be on the look out for the X-Ray charge. Basically, they can help send it through the process quicker so your not getting bill after bill, I was asked to leave a voice mail if they do not answer. It may seem to be a lot but I feel at the end of the day, it helps them to help us with our medical needs. Again, please, if you are having issues, please let our Executive Officers and our Tribal Council know directly by explaining your issues. If they see there are too many issues perhaps they get to the root of the issues and get them worked out so that we CAN get good service all the way around. I am totally grateful to have the health insurance it just needs to be fixed or changed to another carrier if the issues persist.

Thank you for your time, Geraldine Rael, Tribal Member Elder

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