Monday, June 4, 2012

Throwing Account Reps Under the Bus

Insurance companies make me want to go on a mass murdering spree. 13 years of dealing with the same insurance company and I never had a problem. I've had referrals to therapists, dermatologists, fertility specialists, back specialists, physical therapists and so much more in the last 13 years, and never even a hiccup in coverage or any problems of them not paying.

This year, they are making up for the other 12 years of flawlessness.

We all remember the problems I had trying to get a medical referral for The Ginger's oral surgery, right? If not, If This is a Medical Emergency, Please Hang Up and Dial 911 will cover that. That was back in February, and after numerous phone calls and me banging my head against the wall, all of that got sorted out and The Ginger had his surgery in April.

The problem I'm having right now dates back to September, and it's now gotten to the point (well, should have gotten there a long time ago, but I'm a pushover sometimes) where I'm going to call, demand a manager, and everyone I have dealt with about this matter is getting thrown so far under the bus that Satan won't be able to reach them to give them a helping hand. I'm that pissed. I'll explain.

September 24th we moved to Virginia. The Ginger (what is it with the insurance company giving me difficulties about The Ginger? Are they that against red heads?) needed a physical to start school. So, on
September 27th I called the insurance company to figure out the proper way to go about it, and to get him assigned a doctor in this area. That's when the insurance company told me that I'm no longer covered under the South region; we now fell into the North region. So, they transferred me to the North region. The gentleman in the North region was happy to help, said he had transferred me over to the North region, and gave me the names and addresses of several providers that I could take The Ginger to for his physical. All went smoothly... so I thought. I took The Ginger that day, September 27th, to a facility to have his school physical done.

Two months later I get a bill for $300, saying the insurance company denied the claim. WTF? I called them, and they said they never received a claim. So, I called the doctor's office back, and they resubmit the claim.

Christmas came, so I left the whole situation alone for a month, in light of Hubby coming to visit.

January, I got another bill for $300, saying the claim had been resubmitted and was denied again. I called the insurance company, they stated they never received a claim, again, so I called the doctor's office back, and they put my account on a 90 day hold.

90 days later, I got another bill. At this point I was pissed. I called the insurance company (in the North region, because that's where we've been since I called on September 27th and had us transferred), and the woman told me that on September 27th I wasn't in the North region, I was in the South region. Bullshit, I switched us over on the 27th. The woman informed me that I wasn't switched to the North region until the 29th of September, so I needed to call the South region. I called them, and they said they denied the claim on the 27th because I was outside of the network region. No shit, Sherlock, I'm 400 miles north of your region, a region I was switched to on the 27th before I took my kid to the doctor. So, I called the North back and raised hell. They put me on hold forever, and come back with this:

Insurance Company: Yes ma'am, we've done some research, and we see that you didn't switch over to the North region until September 29th, not the 27th.
Me: Okay, do you keep a record of all of your calls, by chance?
IC: Yes, ma'am, we do.
Me: Okay, did I call your facility on the 29th of September?
IC: No, ma'am, according to our records, you were transferred from a call center in the South region on September 27th.
Me: Okay, does your computer tell you about online access as well?
IC: Yes, ma'am, it does.
Me: Okay, did I log into your website and change any information on the 29th of September?
IC: No ma'am, according to our records you don't even have an online account with us.
Me: So, I contacted the South region on September 27th and they transferred me to you all, and I never contacted you all on the 29th?
IC: Yes, ma'am, that's correct.
Me: Then how did I switch on the 29th if I didn't contact you all by any means on the 29th, but I did contact South on the 27th and they transferred me directly to you all then?
IC: Ma'am, I'm placing you on hold so I can go get a supervisor.

I waited on hold for about 10 minutes.

IC: Ma'am?
Me: Yes?
IC: We've done some research, and it appears that you did everything correctly, and in the order you were supposed to, so we're going to back date your entry into the North region to the 27th and go ahead and process that claim for you.
Me: So basically, the guy I spoke to on the 27th didn't do my paperwork until the 29th, huh?
IC: That would appear so, ma'am. But, we're back dating you now, and will be taking care of that claim immediately.

While back then I did the happy dance that I had won against the insurance company, y'all need to know that the conversation above happened 2 months ago. Last month I received yet another bill for $300. I called the insurance company fuming this time. I recapped the entire story to this account specialist, whose first and last name I wrote down, as well as the date and time I called, and she told me that she couldn't find the claim in the system, but she was, and I quote, "Re-keying it back into the system to take care of it."

I received yet another bill this past weekend.

At this point, I have gone through all of the paperwork I have in the apartment. I've found the first and last names of representatives and dates of the last 2 calls to the insurance company- the call where she told me they were back dating me to the 27th and processing the claim, and the call where the second woman said she was 'rekeying' the claim. I'm going to call as soon as they open, ask to speak to a manager immediately, and those two bitches are getting thrown under the bus. I'm so sick and tired of this bullshit, it's not funny. If only I could find the information from the 27th when I called, and that representative's name, I'd throw him under the bus with them.

I do the nice thing for as long as I possibly can, I really do. I have been dealing with this particular situation since November, so 'nice' is far gone by now. Now, the bitch comes out.

Could I have paid the $300 by now? Yes, I could have, numerous times. Am I going to pay it? Hell no, I'm not. For one, it's the principle of the matter. For two, my credit is so far gone as it is, I laugh at a $300 delinquent bill. It's cute, kinda like a ladybug compared to a massive hippopotamus that is the rest of my bad credit.

I'll post an addendum as soon as I speak to the insurance company, I promise. So, if you are reading this pre-bitchfest, then make sure to check back in a few hours. I'm sure it will be epic.


UPDATE: I called first thing this morning, and according to this account rep, the claim had been deleted from the system twice before. Seriously? Deleted? And I chose to deal with this before my morning coffee? Oops. I had her transfer me to a manager, who let me vent for a few minutes to explain the problem, and she said she followed everything I did in the system, so she could verify it all, like I'd be lying about this shit. She said she was going to go to each of the representatives' immediate managers and talk to them about their lack of job performance, and find out for herself why they deleted the claim out of the system instead of doing their jobs.

Do I feel better? Not really. I won't feel better until I no longer get bills for $300 in the mail. I can't imagine that an insurance customer service rep has a mind blowing job. With the economy the way it is, there are a million other people, who can actually do the job, that they could employ instead. Or maybe have the people take an anti-stupidity test before they start work. If the person starts trying to stick the round peg in the square hole, maybe they should pass and go to the next person. Sheesh.





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4 comments:

  1. Oh god bless their hearts!

    Incredible isn't it? I got a bill for fully covered blood work from dd1's pregnancy when she was 18 months old. I spent 4 MONTHS calling the lab and he insurance over $75 because the lab submitted everything as duplicates (same numbers 4x) so ins payed 2 and denied 2.

    Final resolution after HOURS of phone calls: lab messed up. The bill should not have ever been sent to me, but someone put the numbers in the bill to patient column instead of the oops we screwed up column and so much time had passed ins would not pay it anyway. WTF? How hard is it to do a job?

    ReplyDelete
    Replies
    1. Apparently very hard, lol. They need an 'oops we screwed up' column, but the damn thing would be full. =)

      Delete
  2. Stupid Tricare. I love getting surveys from them. I let them have it. The worst part of your particular situation? That shit will go on your credit report. Check to make sure it doesn't stay there!

    ReplyDelete
    Replies
    1. If it does go on my credit report, it'll be in good company with the bills left over from when I owned my own store. They've settled in quite nicely and will show the new doctor's bill how to relax. =)

      Delete

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