PRIOR LAKE, Minn. - A Prior Lake man has won his battle with a major insurance company over thousands of dollars in surprise medical bills.
As a computer hardware and software professional, Jay Craswell is detail oriented.
"I'm very perfectionist," he said. "Like to the OCD level."
So when it came time to sign up for health coverage, Jay says he methodically went through his list of doctors and clinics - one by one - to make sure they were all in-network.
That was Important because Jay knew he had an expensive surgery coming up.
"Everything was yes, yes, yes," he said when he checked online.
But after the surgery, it was a different story.
"When I looked at this bill, everything – everything! - was no, no, no. Out of network," he told KARE 11. "I mean everything."
Since the bills were processed "out of network" Jay would have to pay a higher portion of the total.
Jay says he felt sick, thinking he made a mistake that would cost him nearly $23,000.
"On the stress-o-meter that goes from 1-10, we're at 10," he recalled.
His bills were processed by Blue Cross Blue Shield's Consumer Value Network. During the past year, KARE 11 has reported about other customers of the same insurance plan who also got surprise "out-of-network" bills.
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"I was crying," Julie Smith told KARE 11 last year. "It's a shell game" said her husband Joel.
Jay Craswell was determined to prove he was not at fault. So he went back to the Blue Cross website and started to double check.
"If you ask it the same question repeatedly, it'll give you two different answers," he said as he showed KARE 11 the different results he got.
He even recorded a video of his computer screen as the website gave conflicting answers about whether doctors were "in network" or "out."
"So how does that work?" he asked.
"He's one of the few consumers who actually did all of his homework before purchasing a plan," said Attorney David Holt. He helped Jay fight his bills
Holt says he wound up filing not just one appeal – but five.
"A second appeal with the Department of Health and Human Services, two appeals with Blue Cross Blue Shield, and one appeal with the Minnesota Department of Commerce," Holt said.
Jay's video proof of the computer glitch finally paid off. Blue Cross Blue Shield ultimately agreed to reverse all of the disputed amounts.
"The total amount that Jay owes now is zero," Holt said.
But the attorney still wonders why fixing the mistake took so long – and so many appeals.
"When you have a tool on your website that says, that's what you're going to get, then they purchase based on that, then they don't get that? Then you have to fight them for nine months and get an attorney involved? That's ridiculous," Holt told KARE 11.
A Blue Cross Blue Shield spokesperson told us the company was able to "identify and address" the website issue involving their list of doctors and clinics. They say Jay was the only person they've heard from about that computer glitch.
Julie and Joel Smith got their charges reversed, too, after they proved a different mistake on Blue Cross's website.
The lawyer who filed Jay's appeals wonders if other Minnesotans been billed too much.
"From the state's perspective, I think there should be some investigation into what is going on and how many Minnesotans have been affected there," David Holt said.
Meanwhile, Jay uses a very non-technical term to describe the problem.
"It's truly hosed. Can I say that?" he told us.
Jay used an appeal process through the state Commerce Department to help challenge his bills. You can learn more about it here: http://www.kare11.com/news/investigations/how-to-appeal-surprise-medical-bills/290976791