9 things to know about the massive BCBS of NC system failure

Over the past week, Chapel Hill-based Blue Cross and Blue Shield of North Carolina has been under fire for technical problems resulting in what company executives are calling the most serious system failure in recent decades.

As the deadline for coverage under the Affordable Care Act looms, the largest health insurer in North Carolina has been the cause of great frustration for customers across the state.

Here are nine things to know about the debacle.

1. Consumers were put in the wrong health plans. Approximately 25,000 customers — or 7 percent of all individual customers — across the state were accidentally put in the wrong plans.

2. BCBS ran into numerous billing issues. While some customers have not been billed for their plans, others have been charged for cancelled policies. The insurer also administered automatic bank drafts from 3,200 customers for an incorrect amount. In many cases, this involved withdrawing more than the customer owed or charging customers for multiple plans.

3. Some customers don't know if they're insured. Because numerous BCBS customers haven't received their insurance ID cards in the mail or received them late, they don't know if they have health insurance. Nancy Willis, a BCBS customer, said her plan didn't renew for this year. "I've got doctors' appointments rescheduled — I just cancelled them because I didn't have my card yet," she said, according to The Charlotte Observer. Blue Cross and Blue Shield of North Carolina expects most customers to receive their ID cards by next week, according to a company statement.

4. Phone lines are backed up. BCBS of N.C. said it's experiencing a call volume of 400 percent to 500 percent higher than at this time last year. Although the insurer usually handles about 20,000 calls per day, it received 137,000 on Jan. 11 and 67,000 on Jan. 12. One customer, Stephanie Nelson, was put on hold for more than five hours while waiting for a representative to pick up, according to The Charlotte Observer.

5. The insurer has issued numerous apologies. In addition to posting an apology on Facebook, BCBS of North Carolina's CEO Brad Wilson issued a public statement. "The difficulties that many of our customers who purchased their own health insurance faced this week are unacceptable, and we are truly sorry for this experience," he said, according to The Charlotte Observer. "I want all our customers to know that we're working around the clock to address the situation — bringing in more staff, expanding customer service hours and enhancing our website's capacity."

6. The problems were caused by a new system and a billing company error. BCBS of North Carolina recently implemented a new customer service record system. In addition, Mr. Wilson said the problems resulted from a mistake at Naperville, Ill.-based TriZetto, the insurer's claims processing and billing vendor.

7. A whistleblower has said BCBS of North Carolina knew about the issues in advance. The staff member said the company recently decided to move forward with a software switch to TriZetto's Facet program even though potential problems were foreseeable, according to ABC11.com. "Major problems arose two, three months ago," the whistleblower said. "Company leadership decided we are moving forward with this software no matter what the problems [are] ... It's a catastrophe."

BCBS of North Carolina denied the claim, saying the transition to the Facet program began two years ago. "The system has not only been tested, it has been in operation since 2014," the insurer said in a statement. "The success rate of moving our individual customers to the system was more than 90 percent."

8. North Carolina Attorney General Roy Cooper (D) has gotten involved. Earlier this week, Attorney General Cooper wrote a letter to BCBS of North Carolina regarding the system failure, according to ABC11.com. In the letter, he asked the insurer's executives how and why the problems occurred, and what they're doing to fix it. BCBS of North Carolina has until Jan. 22 to respond to the information request.

9. BCBS of North Carolina has promised the issues will be fixed and customers will be reimbursed. The insurer has extended its customer service line hours and said all customers will be refunded for any incorrect charges. Earlier this week, Mr. Wilson has said the company will need until the end of the week to resolve the problems.

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