Monday, November 16, 2009

Insurance oh insurance...

We had a nice weekend overall. We went to the state park for a walk on Sunday and David maintained his sanity through a ride there, 3 mile walk in the carrier and the ride back. He was hungry but still took things quite well.

Today the insurance drama had to sneak back into my life. UGH! you'd think the company could at least DENY claims properly. NOOOOO! I got delinquent notices from the Pathology lab - a whole slew of them - for bills that I discussed with BOTH businesses just 2 weeks ago (and spent a nice 3 hours dealing with might I add).

Actual conversation with our healthcare company:
After going through the ridiculously extensive menu of options, and staying on hold for 15 minutes, rep says, "yes may I help you?"

Me: yes, (recite member ID number...wait for him to type it...account is on his screen...) I am calling about the Pathology bills I've received for my son David and would like to be connected to the rapid resolutions department to discuss them (so I've done this before - 100 times - and the rep is surprised I even know what the raps dept is much less that I know to ask for it)

Rep: wait just a minute and we'll go over the claims together. First of all congratulations on your baby! Oh, it looks like you had triplets.

Me: yes, I suppose I DID have triplets. My son David has maxed out his life time payable benefit so these bills will not be paid. However, I need to speak with the rapid resolution department so the I can get them denied properly and they can then be reviewed by Medicaid. (try number 2 - still a no go...)

Rep: well if you'll just go through the claims with me, we can see what can be done. What are the dates of service.

(Mary Louise starts crying - I'm with her on this one)

Me: well, there are 17 of them, would you like them one at a time and will you just forward them TO THE RAPS DEPARTMENT PLEASE?!

(David starts to fuss)

Rep: oh it sounds like someone isn't happy. You must have your hands full with 3 at home.

Me: I'm sure I would have my hands full with 3 at home but I only have 2 which is a snap.

Rep: (feeling a little uncomfortable): well I think you need to speak with someone in our rapid resolution department. Will you hold for one moment? Have a good day!

Raps rep: How can I help you?

Me: Do you have the claims in front of you for my son David and did you speak with the first rep about the reason for my call?

Raps rep: yes ma'am?

Me: good, then I need you to deny the claims officially and properly so that it looks as if you would cover them but can't due to the lifetime cap - does that make sense?

Raps rep: I think so.

Me: here is their number, I've spoken to them but would prefer that you do so directly. I'll wait.

Raps rep: it'll be a few minutes.

Me: I understand.

Raps rep: 5 min later: thank you for holding. These claims will be denied and an explanation of benefits sent to the lab in 10 to 15 business days. I can only do 4 claims at a time though so I'll do the next 4 when I have down time from the phones.

Me: I'm sorry, what? So I have to wait until you have a break for you to take care of my claims?

Raps rep: Well, I don't have to have you on the phone. The computer system is set up to only take 4 at a time. They'll be right here for when I get time then I'll send the paperwork out.

Me: please send a copy to my house as well. Thank you for your help.

I then spent an hour discussing the pending claims with the path lab so that they could be marked as such rather than as delinquent. (and the argument with them about our benefits...that's a story by itself...maybe later)

good times...

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