Posted by mair on November 8, 2002, at 20:58:49
In reply to Re: Insurance Company HELL » Dinah, posted by Ted on November 8, 2002, at 18:21:58
Thanks Ted - your post(s) gave me a chuckle too - particularly the bit about being able to truthfully say they were "working" on it.
The trick my insurer employs is to have the most wonderfully friendly, courteous and genuinely helpful customer service reps you could ever ask for. The problem is that they don't make any decisions and don't have anything to do with processing claims. They'll glance at my records in the computer, see that my policy should be paying, and then tell me that they can't figure out why my claims are getting lost or rejected or just ignored. They promise to "look into it" and there things end. Aside from the claim that's causing the current headaches, earlier this year it took over 7 months and numerous inquiries and promises before one customer service rep finally figured out that 7 months of claims were getting either rejected or just plain not processed because my therapist failed to get a new "number" with them when she moved her office. This mystery "number" is apparently necessary regardless of whether you're a provider or not. The customer rep who called me with this news had last spoken to me maybe 3 months before that. I know they all work in the same building, but clearly the mysterious "ways" of the claim processors are as much a mystery to the cusotmer service reps as they are to me.
These are just this year's problems. Last year their deal was to promise a 21 day action program where they'd take action on a claim within 21 days of its submission. I discovered that it was a real Catch 21 for me as to whether I should call to find out what happened with one of my claims because as soon as I made an "inquiry," they'd note that in their computer and my phone call would trigger a new 21 day response period.
I know what you mean also about the absurdity of "normal and customary charges." Both my husband and I see a periodontist. Our dental insurer is supposed to cover 50% of this. One of us will have a semi-major procedure that will cost $300, say. The insurer's "normal and customary charges" are $80, and they will then reimburse us $40 for the 50% share. One can't help but wonder where those professionsals are who are charging $80 when everyone else is charging $300. Surely not in my area or else they'd be driving everyone else out of business. How can it be a "normal and customary" charge if it's not at all available to you at that price.?
I bet we could all go on and on.
Mair
poster:mair
thread:32049
URL: http://www.dr-bob.org/babble/social/20021106/msgs/32060.html