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Monday, December 19, 2011

If You Give Your Insurance Info to 7 Doctors...


Q: If you give your new insurance info to seven doctor's offices by phone a few days prior to your appointment AND have them copy your new insurance card when you arrive in person, how many of those offices will bill the correct insurance company on the first try?

A: One. As for the other six:

One will correct their mistake after you call to give them your insurance info for the THIRD time.
One will state that you have no insurance coverage (while still mysteriously being able to bill your new company, might I add).
Two will have a receptionist tell you your old coverage terminated and they never received your new info, even though you watched this exact same receptionist scan your card at your appointment two weeks earlier.
And the last two will continue to bill your old insurance for 5 months, regardless of how many times you call their office and give them your new insurance info again.

I've described in other posts the amount of time I spend on the phone. Here's how the process goes:

1. I get a statement (not a bill) from the doctor's office. This lets me know what charges they are submitting to your insurance company. I check to make sure that: 1. I actually received the services that they are charging for (you would be shocked at how often they bill you for stuff that never happened!) and 2. they are billing the correct insurance company. I usually have to call them multiple times to try to resolve issues with either item 1 or 2 (frequently BOTH!). After several phone calls, they send the statement with the correct charges to the correct insurance company. Whew!

2. Now my insurance must processes the claim. Then they send me an EOB (Estimate of Benefits). This typically states that this claim has been denied coverage for some (false) reason or another. Then I must call the insurance company. I site chapter and verse from the Policy Brochure the reasons that this claim should be covered. The customer service rep just parrots back whatever the EOB says. I ask to speak to the supervisor, who does the same. I note their names and the date. Just to make sure, I repeat this process at a later date after a session with my voodoo doll.

3. When I still get no help from customer service (I have yet to have any problem corrected over the phone), I write an Appeal letter. This is a somewhat involved process of siting 16 digit claim numbers, CPT codes, revenue codes, and Policy Brochures. I season the appeal with logic and common sense, something that United Healthcare seems to lack. ;) After a month or so, I get a letter back with a ruling one way or the other. God has granted me a pretty high success rate in
these appeals letters. If they rule to cover the claim, they reprocess everything, send me a new EOB, and send the doctor payment.

4. Then, eventually, the doctor will turn around and bill me for the remainder. I honestly have rarely gotten to this step because I've been going through the above process for every. single. doctor's visit, test, lab, or wound care since I changed insurances in AUGUST.

I'm not sure how the health care system is supposed to work... but I'm pretty sure it's NOT like this! This has been an exercise in endurance, patience, and persistence!

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