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Insurance Frustration ....Need a chuckle? Insurance Frustration ....Need a chuckle?

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  #1  
Unread 05-11-2004, 08:45 AM
Insurance Frustration ....Need a chuckle?

Keep in mind, my diagnosis is ANXIETY. If it weren't for the zoloft, I'd be ripping some carcass over this one.

I am having a time getting the insurance company to pay for my last doctor's visit. That was the "how's it going with the Zoloft?" visit. Its not the money, its the principle.

My insurance company first sent a letter saying a 4 digit code was given instead of 5 digits. So, I faxed that letter to my doc's insurance dept and my docs office resubmitted with a 5 digit code. Then the insurance company denies it based on it being too close to my surgery. So, I called and said, it was not a post surgical visit and the rep says that they received a 4 digit code again and instead of just saying that again they used this other reason to deny the claim.

BUT (get this) they won't give me the code they received because that is private information. My information is so private, even I can't have it. Am I on double secret probation? Add paranoia to my diagnosis....

So, I call the insurance person at my docs office and they confirmed that they did submit a 5 digit code. She is going to refile in paper instead of electronically so she can circle the code and write a note. All the while the 90 day time window is quickly coming to a close. I thanked her for her patience, help and understanding and appologized for the hassle.

You know, I already paid the $20 copay, so maybe it would be less frustrating to pay the other $25 and just go on down the road.

s for all my sisters. Thanks for letting me vent.
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  #2  
Unread 05-11-2004, 09:32 AM
Insurance Frustration ....Need a chuckle?

Secret codes- really? I have seen these codes on the internet from time to time if you put the right key words into Google or another search engine. My insurer has them listed on their website so anyone can see them!

I tend to believe your doc's office. Besides, normally in these types of claims programs, you would get an error message if the number of digits entered was not correct. If the company does not have these types of idiot proofing procedures, then they are too stupid to be in business.

You are being treated poorly by your insurance company reps. I work for an insurance company though not in health insurance.
I would send a letter (find out who the Claims Vice President is) saying that if this persists you are pursuing it with the Department of Insurance in your state (the agency that regulates them). In your letter write all the facts; the date/time of your call; what action you took,etc. and what they did. And give names if you know them. The calls are monitored and their managers can get the tapes by date and time and listen to investigate your complaint.

Find out the Claims V.P. either by visiting their website, or calling the switchboard,
  #3  
Unread 05-11-2004, 09:58 AM
Insurance Frustration ....Need a chuckle?

((((Wachusett))))

Those are some good ideas for followup. I hope it does not become necessary to take further steps.

My doc's clerk did tell me they had coded me as having unspecified anxiety because that is where it best falls and there really isn't a better, more specific code to use. She agreed it was absurd when I said the insurance company would not give me my information because it was "private".

I would probably just drop it, but I go in again in a few weeks for a follow up appt to monitor my progress and its going to come up again.
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  #4  
Unread 05-11-2004, 11:46 AM
Insurance Frustration ....Need a chuckle?

Well, "unspecified" anxiety is a VALID illness. Usually it's known as "generalized' anxiety, (people worry about everything and have insomnia and other problems) rather than a having a specific phobia. Another specific anxiety whould be "obsessive compulsive disorder." So, I think your doc's staff is right.

.Anyway, you are in good company- probably millions of people suffer from unspecified anxiety.

In my experience, a lot of medical folks are misusing the privacy angle (the HIPAA law), either out of lack of knowledge or for convenience. Sometimes the insurance clerks are just lazy to do follow up and want to put the burden on you.

And speaking of HIPAA, I think I read a while back that the government is now requiring insurers to use standard codes so that all companies are using the same 5 or 4 digit whatever codes. Your state department of insurance could verify that. If I'm correct, so much for "this is private information"...

I hope no extra work becomes necessary. Don't worry though, you can beat them! And I hope you feel better soon
  #5  
Unread 05-11-2004, 12:36 PM
Insurance Frustration ....Need a chuckle?

Dear ((Michelle))

I have had so many problems with my insurance company that sometimes it makes me not want to go to the doctor... I just want to avoid the hassle... Then I think... well that is probably their goal anyway... make it so difficult that people will just give up and stay home.

Last fall, I delayed surgery at the Mayo for my pelvic pain until I was able to obtain pre-approval with my insurance company... They had 4 weeks to figure it out before my fall surgery date and were unable to come up with an answer (yes, it was pre-approved) until 2 days AFTER the scheduled date... so I had to delay my surgery 3 months.

So the pre-approval was that they would pay 100% of the cost for the surgery at the Mayo (My DH works for a company with really great benefits ON PAPER... it's getting the insurance company to follow through that is the problem). Now I am getting all sorts of insurance notices where they state the charge is covered at 100%.... But then for some unknown reason on the next page they only pay part of the charge. SO then I get a bill from the Mayo for the other part (since Mayo is not contracted with my insurance).

Fortunately my DH has been able to employ the help of a company contact at the insurance company who is trying to sort everything out. She indicates that YES, they were supposed to pay the entire amount and doesn't know why all the checks that were issued were for less... I think they must staff the accounts payable dept with monkeys.

The best strategy we have employed is to work through the company where my DH works.... THe company buys the insurance coverage and so has a vested interest in seeing that the benefits are provided as to the contract they agreed to... It is a mess though and with I imagine they lose alot of money when we have to refile claims that were paid incorrectly.... they could save alot of money and resources by fixing that problem.

Sorry to go on so long... it is just a pet peeve too near and dear to my heart.



Sarah
  #6  
Unread 05-11-2004, 04:22 PM
insurance companies

A quick note about health insurance companies

I went to a workshop in Chicago a few years ago, and a research physician gave a talk on health insurance companies. He said some were found to do things like put their offices above the 6th floor and have the elevators out of business. They also were found to put people on hold for long periods of time, have several layers to get through to get any answers, tell people they were denied and let them go for the appeals. He said the idea was to make it very difficult for most people, esp elderly, ill, etc to pursue small claims because it just was too much trouble for small amounts of money. They can save a lot of money that way and no one will file complaints with state agencies over $25 to 50$.
It sounded pretty cynical, but this physician said it was researched, I don't know where though, and I can't remember where he was from. Anyhow, when I hear things like that, I will fight for the last penny that is coming to me, just so they don't get away with it. I wish everyone well with their insurance company woes.
  #7  
Unread 05-11-2004, 11:59 PM
Re: Insurance Frustration ....Need a chuckle?

  Quote:
Originally posted by michelle35
Keep in mind, my diagnosis is ANXIETY. If it weren't for the zoloft, I'd be ripping some carcass over this one.

I am having a time getting the insurance company to pay for my last doctor's visit. That was the "how's it going with the Zoloft?" visit. Its not the money, its the principle.

My insurance company first sent a letter saying a 4 digit code was given instead of 5 digits. So, I faxed that letter to my doc's insurance dept and my docs office resubmitted with a 5 digit code. Then the insurance company denies it based on it being too close to my surgery. So, I called and said, it was not a post surgical visit and the rep says that they received a 4 digit code again and instead of just saying that again they used this other reason to deny the claim.

BUT (get this) they won't give me the code they received because that is private information. My information is so private, even I can't have it. Am I on double secret probation? Add paranoia to my diagnosis....

So, I call the insurance person at my docs office and they confirmed that they did submit a 5 digit code. She is going to refile in paper instead of electronically so she can circle the code and write a note. All the while the 90 day time window is quickly coming to a close. I thanked her for her patience, help and understanding and appologized for the hassle.

You know, I already paid the $20 copay, so maybe it would be less frustrating to pay the other $25 and just go on down the road.

s for all my sisters. Thanks for letting me vent.
LOL, sounds like my insurance. I suppose I can't use names here. Does it start with an A and end with an A? Mine did pretty much the same thing to me. I was on the phone with them & my drs. office several days. My drs. office said it was the insurance's fault and the insurance said it was the drs. fault, etc. LOL Good luck!
  #8  
Unread 05-12-2004, 08:19 AM
Insurance Frustration ....Need a chuckle?

Well, thanks to everyone for the support.

Basically, my diagnosis boils down to this ... I have many stressors in my life and the zoloft seems to be helping me to work through all of that.

I am goal oriented and highly motivated and although that makes me the kind of person that people can really rely on and depend on, it has its down side. The goals tend to take over and then I hit the wall because I just couldn't let them go. My husband and I are 2 peas in a pod, so we just feed off each other, stress-wise. I am doing much better handling it all on the medicine.

I look forward to one day retiring to the country to live with my horse(s) and then I probably won't need this medicine. At least my doctor seems to think I won't need to be on it forever.

Take care, everyone!!!
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