Hoops all the way down

Cartoon-thumbBefore I get into the meat of this post, let me first say that the way we handle health care in the U.S. is dumb and a disgrace. Okay. So, I think it was two years ago that my employer switched to our current provider. They sent us new ID cards, as usual. What was unusual was that the cards also came with these cute little tyvek envelopes, and the envelopes had additional information.

The size of the text on the cards and the envelopes is extremely tiny and difficult to read. There are multiple phone numbers, mailing addresses, all sorts of information. The company is headquartered in the midwest, and since they don’t have offices at all on the west coast, those of us working in the offices in Seattle and the various California locations are supposed to submit things through a local insurance network for reasons that don’t completely make sense to me. That’s one of the reasons there is so much information crammed on the cards and envelope: there is contact information for multiple offices.

The first time any of my health providers tried to submit claims…


…those claims were rejected with a message that they had no record of me being a member. After many back-and-forths of both myself and the provider calling the various 1-800-numbers on the cards, and more rejections (with the people on the phone not being able to figure out why things were being rejected), we eventually tried re-submitting the claim using my Social Security Number as the ID instead of the ID Number from the medical card.

And the claim was paid.

This was repeated with my pharmacy. And then with a lab my doctor sent me to for some tests. So when I went for my annual visit to a specialist I see, I advised them not to use the number on the card, but rather submit using my SSN. That was the only claim paid the first time a new provider submitted it.

I should mention that the first few times I called the insurance company’s customer service number, they couldn’t look me up using the ID number from their own card. They also had to resort to searching on other information to find me.

As you might guess, I’m grousing about this because it’s happened again, and with a new wrinkle. A few months back I had an incident requiring a visit to an emergency room, and there have been all sorts of subsequent doctor visits, tests, and treatments. There were a few of the usual fumbles along the way, as several new providers were involved. But I thought things were mostly getting handled.

Then I got a bill printed all in red from some place that I didn’t recognize. They said my insurance company had claimed I had no coverage, and this was due now, now, now!

So I call their number, and after a bit of wrangling, I finally figure out that this is the separate bill from the doctor at the emergency room, but he does his billing from an association that is headquartered in Oklahoma, and he was mentioned only once on the bill they sent me, in very small type in a paragraph that looked like it was some sort of legal disclaimer. (And it isn’t a regular doctor, so even if I had noticed his name I might not have recognized it. We talked for all of two minutes in the emergency room.)

Anyway, the customer service person on the phone was able to confirm that, even though this piece of paper said Final Notice and made other dire pronouncements, it was the first time they had sent anything to me. They had made multiple submittals to my insurance, but hadn’t even sent me one of those “your insurance has been billed; this is for information purposes, only” notices that these places sometimes do. So I confirmed that she had all the same information that was on my card, and asked if she could re-submit referencing my SSN instead of the ID number on the card. She then explained they had a policy not to reveal patient SSNs, and said I should sort things out with the insurance company myself.

I called the insurance, and their records said that the physician’s billing service had failed to provide a description of services rendered. They advised me to call the billing place back and instruct them to call the 1-800-number for providers, “that way our claims department can sort it out.”

When I called this place back, she told me, “We can’t call out from here. I can only answer calls and mail claims.”

WTF?

So then I wound up playing relay, because apparently the claims department at my insurance couldn’t call this billing place, either. (At one point I asked, “Can’t I just mail this final notice thing to you guys with a cover letter with all of my information and then you pay it?” Apparently that wasn’t allowed, either.) But eventually it seemed we had it worked out, and the claim was re-submitted.

Until I got another bill from the physician’s biller, telling me that my insurance company now claimed that they weren’t my primary coverage, and I should submit it “to your wife’s insurance first.”

I have a legal spouse, but not a wife. That minor annoyance aside (really? they’re using gendered nouns?), my husband’s employer-provided insurance covers almost nothing, and charges an ungodly premium to cover spouses or dependents, so we had never added me as a subscriber over there. He has multiple coverage, but I don’t.

I learn that the insurance company now has a policy that every 90 days they send out the questionnaire asking customers to confirm that we have no other insurance. For decades I’ve been getting that sort of form approximately once a year. Every insurance company does it, hoping to get out of paying entire bills by making another insurance company chip in. But now they’ve decided to do it once every 90 days. “And you didn’t send back your last survey.”

I couldn’t remember when I last received one.

“The new form includes some educational material about the insurance process,” the customer service person explained. “A lot of people are mistaking it for junk mail.”

This customer service rep was able to offer an explanation of the other problem. It has to do with using the local networks. If the claims person at the local network doesn’t recognize that the member ID number isn’t in the same format as their own usual ID numbers, they don’t know to search for me as a member of an allied network. So if they just enter the ID number on my card into their ID number search, I don’t come up.

Brilliant.

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About fontfolly

I've loved reading for as long as I can remember. I write fantasy, science fiction, mystery, and nonfiction. I publish an anthropomorphic sci-fi/space opera literary fanzine. I attend and work on the staff for several anthropormorphics, anime, and science fiction conventions. I live in Seattle with my wonderful husband, still completely amazed that he puts up with me at all.

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