February 2013 Moms
Puck1182
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Insurance company vent (long)
Puck1182
member
The incompetence of our insurance company reps never ceases to amaze me.
Back in November, DH passed out and was taken to the hospital in an ambulance (only to be told he was perfectly fine and he was free to go - he has panic attacks in large crowds and that's all it was). Our insurance company paid the "allowable amount," but the provider (the FDNY) was "our of network" (we're in a PPO) and we were billed for the rest.
We had a similar situation about a year ago, when DD had to be taken to the emergency room and we went to a participating hospital, but we didn't get to choose the ER doctor. He was out-of-network and when I called the insurance company to ask why it was billed that way, they said they'd send me a check for the balance of the bill since we did not have the option to choose our provider, so I figured this would be the same kind of deal, seeing as DH did not personal select a provider to bring him to the hospital, and indeed did not even call the ambulance in the first place.
I called back in March and the customer service rep told me she'd send it to review (which at the time I did not realize was different than an appeal) and that I'd get an adjusted EOB in the mail. 2 1/2 weeks go by and the FDNY is calling us asking about the money. So I called Capital BlueCross (yeah, that's right, I'm naming them, don't even care) and asked about the status of the appeal. Note that I explicitly used the word "appeal," not "review," because I thought that's what it was. She told me I should get an answer in a few days.
Another 2 1/2 weeks. Another call from the FDNY. I called CapBlueCross again to ask the status of the appeal. The girl said she'd send a message to someone in the appeals department and someone would call me as soon as possible (again, no mention that it went to review, not appeal). This was April 30. As of today, no call.
I called them AGAIN this afternoon. The lady finally informs me that there's no appeal on that claim, and I should mail or fax one to them. I called the FDNY to give them the update and get their fax number so I could copy them on the appeal info. The lady told me that I shouldn't do the appeal, I should call the insurance company back to let them know that it was an emergency transport. This confuses me, and I call them back again. At this point I'm so confused and annoyed, and the customer service rep I got that time wasn't helping, so I got fed up and asked to talk to a supervisor, because at this point I've been given incorrect information for the past two months, and I feel like as a courtesy they should just pony up the balance to make up for their screw-ups.
I end up on the phone with the supervisor (who said the first employee should never have put the claim through review because it wasn't the sort of issue that would be eligible for the review process) and then HER supervisor for a total of an hour. She insisted that all I could do was file an appeal (which she couldn't guarantee would be granted), and I could also file a complaint about the customer service (but they wouldn't reimburse us based on their shitty, shitty, incompetent employees fuck-ups anyway, so fat lot of good that will do).
I have been having the woooorst digestive troubles over this whole situation, because I hate, hate, hate stuff like this being up in the air. They strung me along with incorrect information for two freaking months. Yes, theoretically we can afford to pay the balance on the bill, it would hurt our budget for the month significantly but it's not like we'd have to choose between that and food... but at this point it's a matter of principle. This. means. war.
In addition to faxing an appeal and a formal complaint tomorrow (and CCing the FDNY on it so they have the information on the situation in writing), I'm speaking to our benefits coordinator to see if she can put a little pressure on them, and they are getting an angry call from me every single day until they send us a check to cover the rest of the bill. Even if I have to do it every day for the rest of my life. >:P
Congratulations if you made it this far. I know there are worse things I could be dealing with, but I'm fed up with this crap, I can call our insurance company with a question multiple times and get a different (usually incorrect) answer every time, and it's been like this for at least 6 or 7 years. I'm so fed up with it.
Back in November, DH passed out and was taken to the hospital in an ambulance (only to be told he was perfectly fine and he was free to go - he has panic attacks in large crowds and that's all it was). Our insurance company paid the "allowable amount," but the provider (the FDNY) was "our of network" (we're in a PPO) and we were billed for the rest.
We had a similar situation about a year ago, when DD had to be taken to the emergency room and we went to a participating hospital, but we didn't get to choose the ER doctor. He was out-of-network and when I called the insurance company to ask why it was billed that way, they said they'd send me a check for the balance of the bill since we did not have the option to choose our provider, so I figured this would be the same kind of deal, seeing as DH did not personal select a provider to bring him to the hospital, and indeed did not even call the ambulance in the first place.
I called back in March and the customer service rep told me she'd send it to review (which at the time I did not realize was different than an appeal) and that I'd get an adjusted EOB in the mail. 2 1/2 weeks go by and the FDNY is calling us asking about the money. So I called Capital BlueCross (yeah, that's right, I'm naming them, don't even care) and asked about the status of the appeal. Note that I explicitly used the word "appeal," not "review," because I thought that's what it was. She told me I should get an answer in a few days.
Another 2 1/2 weeks. Another call from the FDNY. I called CapBlueCross again to ask the status of the appeal. The girl said she'd send a message to someone in the appeals department and someone would call me as soon as possible (again, no mention that it went to review, not appeal). This was April 30. As of today, no call.
I called them AGAIN this afternoon. The lady finally informs me that there's no appeal on that claim, and I should mail or fax one to them. I called the FDNY to give them the update and get their fax number so I could copy them on the appeal info. The lady told me that I shouldn't do the appeal, I should call the insurance company back to let them know that it was an emergency transport. This confuses me, and I call them back again. At this point I'm so confused and annoyed, and the customer service rep I got that time wasn't helping, so I got fed up and asked to talk to a supervisor, because at this point I've been given incorrect information for the past two months, and I feel like as a courtesy they should just pony up the balance to make up for their screw-ups.
I end up on the phone with the supervisor (who said the first employee should never have put the claim through review because it wasn't the sort of issue that would be eligible for the review process) and then HER supervisor for a total of an hour. She insisted that all I could do was file an appeal (which she couldn't guarantee would be granted), and I could also file a complaint about the customer service (but they wouldn't reimburse us based on their shitty, shitty, incompetent employees fuck-ups anyway, so fat lot of good that will do).
I have been having the woooorst digestive troubles over this whole situation, because I hate, hate, hate stuff like this being up in the air. They strung me along with incorrect information for two freaking months. Yes, theoretically we can afford to pay the balance on the bill, it would hurt our budget for the month significantly but it's not like we'd have to choose between that and food... but at this point it's a matter of principle. This. means. war.
In addition to faxing an appeal and a formal complaint tomorrow (and CCing the FDNY on it so they have the information on the situation in writing), I'm speaking to our benefits coordinator to see if she can put a little pressure on them, and they are getting an angry call from me every single day until they send us a check to cover the rest of the bill. Even if I have to do it every day for the rest of my life. >:P
Congratulations if you made it this far. I know there are worse things I could be dealing with, but I'm fed up with this crap, I can call our insurance company with a question multiple times and get a different (usually incorrect) answer every time, and it's been like this for at least 6 or 7 years. I'm so fed up with it.
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Re: Insurance company vent (long)
Those types of problems are so frustrating. Sorry you're having trouble
First round of Clomid in May 2012= BFP #1, DD born January 2013
BFP #2 in January 2014, DS born September 2014
When my husband's old therapist was leaving our network, we wanted to do a price comparison to see if paying the out of network amount to stick with her, and the jerks absolutely refused to tell us what the allowable amount was, even with the caveat that it was subject to change and only effective as of that date. It was infuriating, they told us the only way we could find out was to stick with her and file claims and wait for the EOB, which defeated the purpose of comparison shopping. But oddly enough, after hours and hours of me on the phone with them in tears because they took forever to process the claims and we wound up owing a bunch, the allowable amount just happen to increase to cover almost the entire visit. I think they got sick of me, so I'm banking on that happening again. ;-)
Eli 6.18.09 35.5w
Silas 1.25.13 35.4w 10 days NICU, allergies/asthma, gluten intolerant
They messed with the wrong chick this time.
I just sent a lengthy appeal letter, complete with exhibits of a previous claim that was adjusted to cover the full charge due to similar circumstances, and a formal complaint about the customer service along with a copy of my phone records showing the times and dates that I called.
Starting tomorrow they get a follow up call from me every single day until I hear back, since they have already shown me that I can't believe they will get back to me on their own.
I feel like the parent of a teenager who just had privileges taken away because they proved they weren't trustworthy. It's beyond ridiculous.
I also found out that it's possible the FDNY violated DH's right to refuse medical aid. I found their RMA policy online. Going to request all their documentation on the call, because if they didn't inform him that he could sign a form to release them from liability and evaluate him to determine if he had the capacity to refuse after he told them he didn't want to go, we may have legal grounds to sue.
Seriously folks. Don't mess with a librarian with OCD. :-p