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Starting to Lose it Here a Little

Discussion in 'Dysregulation' started by nor, Nov 9, 2007.

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  1. nor

    nor Well-Known Member

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    Ok-trying to keep it together here.....

    My insurance company has once again tried to deny my doctor appts. There is only ONE f^&&ing person that knows what the HELL is going on!!!! I had one woman leave me on hold for 35 minutes. I called back on my cell phone and got someone else, in trying to reach the ONE person who knows anything!!!!! Everyone tells me a different story and I am getting very stressed about it! The woman I needed to talk to was busy and on another line-so noone can tell me anything until Monday!!!!!

    The woman I spoke with told me that she would "go over it" with the knowledgeable one, and get back to me after 12 on Monday.

    I can't even discuss what the first one said to me (the one who had me on hold for 35 minutes)-or I will really lose it!!!!!

    The battle ax of a secretary at the doctor's office is going to have a fit!!!

    And it ALWAYS happens on weekends!!!!!!!


    nor
     
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  3. 2quilt

    2quilt I'm a VIP

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    I know what you mean! I used to do customer service work for a health insurance company and people would call and ask specifically for a certain employee because there were a few great employees who really knew all the stuff well, and did the job well, and if the customers locked onto them, they always asked for them, especially if they had difficult cases. When you get ahold of that special customer service person, find out what hours they are on the phones, their extension, their boss's name so you can ask for their boss in case you need to get a phone transfer, and write a nice letter to the company, because that will go into his or her permanent file, and he or she will remember you and be forever willing to help you.
    Find out why the insurance wants to deny your claim. It may be something simple like a diagnosis code number off by one digit. Get a notebook and document every time you call the insurance company because you best believe they document every time you call them! Document the date, time, who you spoke to, and what was wrong with the claim or why this person said the claim was denied and if this person told you they were going to take any actions. You have all kinds of patient rights. Never give up. You pay for that insurance! They work for you! Best time to call is first thing when they open.
     
  4. Seeking_Nirvana

    Seeking_Nirvana I'm a VIP

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    I'm having that problem too. I'm taking my doctor bill into the doctor's office with me my next appointment to show them exactly what diagnosis they messes up, so they can fix it and resend it to the insurance company.

    If I call them and try to relay this info over the phone it will be an hour for them to figure it out, and it still wouldn't get done. I always get the best results by going to their office and talking about it there.

    I'm not sure if you can do that with your doc and insurance company, but it really goes a lot better because they have to help you if your standing there in their face and refusing to leave until they fix it.

    They will want you gone ASAP so they will find your file and fix it while you wait and stare at them.

    2 quilts idea is better, but I will have to remember to do what she recommended. In my case it's too late to call back and find the original person I spoke to. So it will be easier for me to take the bill with me this time.

    Good Luck!
    Tammy
     
  5. cactus_jack

    cactus_jack Well-Known Member

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    Find a lawyer and discuss this with them. Mention the idea of the insurance company doing a bad faith contract.

    If your lawyer discusses bad faith with the insurance company, it could hurt your case. But it can also help it tremendously. So it's really a crap shoot.
    Your call. But certainly discuss it with a lawyer. Their insight is valuable here.
     
  6. nor

    nor Well-Known Member

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    My sincere thanks TwoQuilt and Tammy!!!

    I did give the girl I dealt with a verbal recommendation to her boss the last time she straightened everything out.

    Most times the other representatives will transfer me to her line (and I wait until she answers), but yesterday I had someone that told me they can't do that, and then put me on hold forever. I then called on my cell phone while I was on hold on my home phone.

    I have been briefly documenting my phone calls and I still find that there is only one who knows her stuff. It is scary to think just how many people out here are not getting the coverage they are entitled. If I didn't pay top dollar for the coverage I get, I would probably just say "ok" and then start to pay my doctor myself. And I KNOW that if I hadn't hooked into the one woman who knew her stuff that I would have also paid out of pocket. I am on the verge of doing that anyway just to get rid of all this stress I'm experiencing-but I am not made of money.

    I was going to wait until I got back from my doctor's office Monday afternoon to try and call her, but because of your advice TwoQuilt, I will definitely be on the phone at 8AM Monday morning.

    Many thanks
    nor
     
  7. 2quilt

    2quilt I'm a VIP

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    Nor and Tammy

    Don't give up, Nor! Think of the money you have already shelled out to that insurance company to do their job!
    They want you to give up and take the path of least resistance and just pay more out of your own pocket so you can move on to make this problem go away. That's how big health insurance companies think.
    Breathe.
    I am here to help you through this.
    We will do this together, and we will win.
    I worked for one, and they screwed me too.
    You deserve a correctly processed claim that pays fairly!
    All you owe that doctor's office is a simple copay.
    If he is contracted, in-network, his contract states that he has to write off any amount that your insurance refuses to cover. End of story. If there is some question concerning the doctor's status of in-network or not, that's easy. Referral dates can be back-dated. Diagnosis and procedure codes can be changed and resubmitted, if the provider really wants to get paid...

    this stuff is done hundreds of times on a daily basis. The patient should not be so involved with the pain of billing problems; that should be between the provider and the insurance company. The average patient does not understand enough about the intricacies of patient billing and health insurance benefits 15 volumes thick plus loopholes and periodic changes to *want* to be subjected to this crap. This is why I did this for a living for a while, because I really enjoyed solving problems for angry, distraught people who called me up cussing my name because I represented the worst health insurance company in the US. I really loved my job. Because I worked with the caller to solve their problem, we worked together against the common enemy, my employer. Of course, I did not express that too obviously on the recorded line, but I did work enthusiastically to get callers their money.
    Don't give up!

    2quilt
     
  8. nor

    nor Well-Known Member

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    Hi 2Quilt,

    Well, I finally got through to them this morning. I called right at 8AM, but the girl I needed to talk to wasn't in, so I left a pleading voice mail message.

    She finally called me a little after 9 (I told her that I HAD to have it resolved before I left for my doctor's office at 9:30).

    Anyway, she said that there was a misunderstanding on her part (shit), and I knew then that it wasn't going any further.

    According to my coverage, I am allotted 40 visits a year. With the new Timothy's law, 20 of those visits are now covered 100%, while the remaining 20 are only covered 50%. Supposedly they are now being handled correctly, and I will be paying 50% of the doctor's visit until the other 20 are up (which should be any session now). Then, I am responsible for the full amount.

    I completely agree with you about the giving up part. I did. I knew that when my Blue Cross (yea-another Blue Cross/Shield) woman said she had a misunderstanding, that it was the end of the road. I just couldn't fight it anymore. The other reason I let it completely go, is because I always knew that I had 40 visits a year at 50% coverage. The only thing that WAS different this year, was the 100% coverage of the 20 visits. So when she explained that the Timothy's law add on was responsible for the additional coverage for the 20 visits-I gave in. It just wore me out completely.

    At least now though, I still have my 40 yearly visits (contrary to many other reps from Blue Cross), and 20 of them are fully covered. I also have the names of two of her supervisors (one of which I left a verbal recommendation a couple of weeks ago). I am sure that this will not be the last of it for this year-and I am positive that it will all start up again next year. I only pray that the one woman who knows what is going on, doesn't get promoted to another department, or leave.

    I explained it to my doctor's office, and the secretary just shook her head. All she wanted to know, was how the doctor was going to get paid. And now that is taken care of.

    I was so afraid to take it any further with Blue Cross, because they had threatened to take money BACK from my doctor because I was supposedly not entitled to the coverage at all. They are too freakin powerful!

    Thank you for all your support and input. You don't know how very very helpful it all was (and still is!!!). We pay top dollar for the most expensive coverage (are you familiar with Blue Million?), and it is as though they pick and choose what they will cover. AND it will change from time to time!

    And they wonder why I need a psychiatrist!

    Many many thanks
    nor
     
  9. 2quilt

    2quilt I'm a VIP

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    I have never heard of Blue Million, but it sounds like a joke, like "yeah, that's how much it costs" or "that's how many customers we screw" or "that's how often your claim will process correctly, once in a million." What I really hate is that your 40 is ending, especially coming up on holiday season. Now I have a question: Does your new "year" begin in January or in August or some other month? Also, would your doctor make a private pay cash deal with you for those visits not covered by Blueshits, until your health insurance kicks in again? Want to try asking? He or she knows you can't afford much, but find out what Blueshits pays at 50%, and negotiate. That saves office paperwork and payment wait time. I am pleased to help you any way I can!
     
  10. nor

    nor Well-Known Member

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    Hi-I had a talk with my doctor yesterday about the urgency to see him in the next couple of months, and I think he finally understood. I have booked two appts a week for December, and just waiting (on pins and needles) for that "final" coverage payment for the year. I can go back and count how many times I have gone, but I am afraid to do so. My stomach is already in knots and I am afraid I will lose it more if I find out exactly when the last visit is.

    My coverage starts new in January. There is a $100.00 deductible which needs to be met, and then they will start paying. It always gets tough around this time of the year.

    What is a "private pay cash deal"? How would that work? I can talk to him about that next visit!

    How satisfying to have Blue Cross referred to as BlueShits-so appropriate. Thanks for the grin.

    nor
     
  11. 2quilt

    2quilt I'm a VIP

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    What I mean by the private pay cash deal is that before the insurance coverage stops completely for 2007, maybe you and your doctor could work out a smaller cash payment plan than what Blueshit demands that you pay him. If you two did that he would not have to file those visits to Blueshit, those dates would not would not matter in the official count of 40 anyway because Blueshit isn't putting out any money at 100% or 50%, so these end of year visits would just be between the two of you. Does that make sense? Let me know if you need any help.
     
  12. nor

    nor Well-Known Member

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    I could try and talk to him about it, but I don't think he will reduce his price for me. As it stands now, Blueshits doesn't completely cover his total charge, so he justs rights the balance off for me.

    I know for sure, that next year, I will keep a very close eye on the number of visits, so that I don't run out of them around the holiday time!

    Thanks for all your help! It is GREATLY appreciated!!!

    nor
     
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