Dec 032004

If you read in the news about someone going on a murderous rampage in a medical insurance office, that will probably be me.

But wait, let me give some history here. Back in the spring, my mate’s employer changed its insurance carrier. They seem to do that about once a year.

Usually when you go to the doctor’s office, the helpful receptionist will ask you if you’ve had any insurance changes. This would remind me to give her our new insurance card, and all would be well.

The pharmacy, however, never does this. And I never thought about it; they just kept using our old insurance information until—four months later—the old insurance company finally stopped accepting claims. Only then did they get the new insurance information.

Several months after that, we get a dunning letter from a collection agency. Seems the old insurance company has turned the erroneously-paid claims to their collection agency, without ever trying to contact us about them. I’m a bit peeved about that.

So I spent a day playing phone tag with the old insurance company, the new insurance company, and the pharmacy where the prescriptions were filled. The old insurance company says I need to talk to the new one. The new insurance company says I need to send in a claim form with copies of the prescription receipts, and they will mail me a batch of the claim forms. The pharmacy seems to be the only one actually able to do something halfway productive, and tells me my copies of the needed receipts can be picked up in a couple of days.

So I fill out the claim forms, pick up the copies, tape them to the forms as per the instructions, and mail the whole package in. Whew, one less stupid hassle dealt with.

Not so fast! A couple of weeks later they all come back to me in the mail, with a note from the insurance company that I have to provide proof that the other insurance company denied them. Okay, oversight on my part, I probably should have thought of that. I make copies of the dunning letter from the collection agency, add it to the pile of paperwork, and send it all back.

Yesterday in the mail I got two responses from the insurance company. The first one has one of the claim forms, including the prescription receipts from the drug store, and it says the claim was denied because we weren’t eligible for coverage on the date it was filled. (Incorrect, we checked that before we ever started this whole mess.) The other one has the remainder of the claim forms, and it says it was denied because there are no prescription receipts. All five prescription receipts, the ones I had to get the drug store to look up and re-print, have been carefully removed from the paperwork.

So it looks like I’m going to be spending another day playing phone tag, trying to a) force them to admit that we have been covered since April 1, and b) finding out how, exactly, I’m supposed to send in prescription receipts so that they will not be removed and lost by the insurance company. I’m beginning to long for the carefree days when we were trying to get our mortgage refinanced.

The really annoying thing is, I run into this all over. The kids we hired to fix up the yard did a great job planting new shrubbery, but never did come back and haul off the old bushes they cut down. I eventually had to get someone else to do it, and now I get to be the bad neighbor by asking them to reimburse me for the money I paid someone else to finish the job I hired them to do. I’ve been putting it off because I don’t want to wind up in a quarrel with the neighbors, but at the same time we paid them very well and the brush then sat beside our driveway for over two months. I had to phone them four times before I found out they hadn’t returned because their “trailer is broken.” And of course before that was the saga of the refinance. It’s amazing how long it can take to straighten these things up.

And it’s amazing how frustrating it is having to go clean up someone else’s leftover mess. I think next time it happens I may just have to go punch someone in the face. Watch for me on the news. “Deranged Woman Assaults Claims Adjuster.” What do I have to lose? They’ve already denied my claim.

 Posted by at 11:30 am

Sorry, the comment form is closed at this time.