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Members report denials and mis-mailed ID cards; carriers and HSS to investigate
Summary
Public commenters told the HSS board that denial letters and a departmental memo made it hard for members to get help with fertility benefits, and several retirees reported receiving ID cards from the wrong carriers. Delta Dental and Blue Shield representatives promised follow-up and HSS staff said they would investigate.
Several public commenters raised access and communications issues with carriers and HSS during the Jan. 9 Health Service System board meeting.
Bridal Maybaum, identifying herself as a city employee, said that members denied benefits for fertility-related care were not provided with a "preliminary diagnosis" and that the department’s internal memo does not clearly direct members to the employee at Blue Shield who helps with denials. "Denial letters are form letters," she said, adding that finding the dedicated Blue Shield staffer has required personal outreach.
Richard Rothman, a retired employee, described confusion at a Kaiser facility over shingles vaccine distribution and how multiple facility lists prevented staff from knowing who was on a waiting list.
Delta Dental’s Sharon Staneklo said she had checked enrollment screens and would follow up with Rothman directly. In later public comment, Dennis Krueger and others said they had received Blue Shield ID cards despite being enrolled in UnitedHealthcare or Kaiser; Blue Shield’s Sean Lebring said experimental procedures are generally not covered but that teaching hospitals often absorb study-related costs and that coverage questions are handled case by case. HSS staff acknowledged the reports and said they would investigate whether a systems or confidentiality issue caused mis-mailed cards.
What happens next: Carrier representatives and HSS operations staff will follow up with individual claimants and investigate the root cause of the mis-mailed cards and member-navigation issues flagged in public comment.
