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Customer Service is Dead – Installment #2 (Part 2)

October 3, 2007

So Cindy called back (gasp) and let me know that the insurance company told her that there absolutely would be a $15 copay for the shots. She checked with Jennifer and Jennifer agreed that the insurance company told her there would be no copay, but she didn’t have the name of the person to whom she had spoken. That was it. Bottom line.

My turn to fight with the insurance company.

I dialed them up and went through the 80,000,000 voice or number-entry driven menu options that finally netted me a real voice on the other end of the line. She was even very pleasant. As I described my issue, she seemed to know rather quickly exactly what I was talking about. She stated that the shots should be covered at 100% and that the way it got paid was dependent on the way it was submitted by the billing folks.

Of course.

Now… why I didn’t get her name and a reference number at this point is truly beyond me. I’ve done enough of this go-’round with this and many, many other companies to know that I should always have that information. Maybe it was just my excitement at being understood so quickly and getting such a succinct answer. Either way, I hung up the phone and dialed Cindy back.

By this point, it was late in the afternoon and Cindy had evidently gone home. One of her partners in crime listened intently as I explained my situation for the umpteenth time that day and said, “Do you have the name of the person you talked to? Or a reference number by chance?”

***crickets***

Hmmm…. no. Bummer… no reference number, no name. Big sigh.

“I’ll call them back and get that information and get back to you,” I said. “In the meantime, since I’ve had a chance to examine this a little more closely, could you explain to me why I have a couple of shots on this bill with no copay and the rest that require a copay?”

She was silent for a second, then asked for the account number. I gave it to her, and she reviewed the file. I had two dates of service (the first two) that did not show a copay required, but her system showed one required on all dates of service. She explained that if they had received notice from the insurance company that a copay WAS required, then they would retroactively add it to the account. Awesome.

I called the insurance company back and got a pleasant enough gentleman on the line (after the 80,000,000 voice and number-entry driven menu options). What I really wanted was for him to transfer me to the person to whom I’d spoken previously. I thought that perhaps she and I could conference in the billing folks and get it all straightened out.

Wouldn’t you know that the previous person wasn’t in the same office, and therefore this guy could not transfer my call to her. I settled for requesting her name and a reference number. Evidently this guy was a multi-tasker because he provided me with her name and reference number, and then went on to explain how the billing issue might have come about.

He and I went a couple of rounds, with me explaining exactly what I was seeing on the bill, him cross-referencing the procedure code, etc. Finally, I just asked him to conference in the billing folks so we could all get on the same page… at the same time.

He agreed. Excellent. I actually thought we were on the way to closure here. Ha!

Once we got the billing folks on the line, Insurance Dude changed his tune. 100%. Suddenly, it wasn’t that the procedure code was off, it was that the billing folks had the right to bill for the office visit, in addition to the shot. He read the policy, and it sounded a lot to me like they could only bill for the office visit if the shot was administered by a physician, which it never has been, but the billing folks stood their ground–they insisted that they had ONLY billed for the shot, no procedure code for the office visit at all.

As we all three went back over the bill, the billing folks noticed that the insurance company actually had paid out the whole thing for the first two, and then had dropped their payout to the provider by $15, exactly the amount of the copay… the one he said the billing folks had to specifically bill for… that the billing folks had NOT specifically billed for.

Finally. Some progress. Sort of.

Insurance Dude spent the next five or so minutes arguing with the billing folks, until I got tired of listening to him drone on and I said, “What can we do about this, then?”

The billing folks suggested that the Insurance Dude resubmit the claims, correctly, with a note on the payout, including the part of the policy that says there is no copay unless it’s administered by a physician, which has to be submitted under a different procedure code.

He thought about it for a minute, huffed and sighed, agreed to re-submit, and gave me a HUGE disclaimer about how he couldn’t guarantee that it would come out any differently this time. Oh, and it would take at least 15 business days before anyone heard anything from them. Superb.

The billing folks agreed to note on our account that it was being resubmitted to the insurance and agreed that they would NOT send us to collections or some other stupidity.

I felt better for the moment, but I fully realize that 15 business days from now I will likely be having the same conversation with the insurance company. While the policy seems to state clearly that there should NOT be a copay unless the shots are administered by a doctor, I have NO idea who actually reviews the claims for payment, and (you guessed it)… THOSE offices are separate from the offices where Insurance Dude and his cronies live.

I wonder how efficiently the telephone game works in the insurance industry?

Any bets?

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4 Comments leave one →
  1. clevergrl permalink
    October 3, 2007 7:17 pm

    What a pain in the ass.

    On a positive note, my brother had really bad allergies when he was growing up and the shots all but cured him. He has few problems now, mostly just in the spring and fall, which is what I get.

    I hope they work as well in your case!

  2. Lynda permalink
    October 4, 2007 8:26 am

    I hope it all gets worked out. I’ll be anxious to hear the end results! I echo clevergrl’s sentiment that I hope the shots work well for the kids and make them feel tons better!

  3. October 4, 2007 10:33 am

    15 Days? I can’t remember a conversation after 15 minutes. How do you pick up on that one when you will “have to” call back?

    My girl-doc sent me home with all the forms for me to submit to the Insurance Company. 1st, if you fax more than one sheet, they look at the top one and ignore any others – so one claim per fax. Second, they claimed the procedure code was inaccurate…after several faxes (was it blurry? did it smudge? did it run off the page???). After 13 phone calls back and forth to girl-doc, she finally read it to me out of the Procedure Code Bible, exactly what the number should be. I faxed the claim, same as all the others before it, and somehow, in some universe, this time they liked the procedure code. And that was just for a physical. I have high blood pressure just reminiscing.

  4. October 4, 2007 1:34 pm

    Let’s hope I don’t have these kinds of issues when I take My Favorite Puker in for his procedure…

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