Monday, July 13, 2009

Phone call

Call to "Freda" an insurance:

Me: My pediatrician says that the claim wasn't paid for 5/12 5/15, 5/20, 5/22 for both Eli and Elsie. They are twins, and were both seen by the doctor on those days.

Freda: Nope, those claims for each child were paid. There is no remaining balance.

Me: Are you sure? For both babies?

Freda: Yes Maam, I'm sure. All the claims for both babies have been paid.

Me: Okay, well I guess I'll call the doctor's office and if they still say the claims weren't paid, I'll call back?

Freda: If that's what you want to do.

Next Call is to April from pediatrician's billing department. She explains in full detail each claim date for each child, and exactly what percentage insurance should have paid, and didn't.

Call back to "Freda" at insurance:
Me: I just spoke with the pediatricians office, and she told me there is ABSOLUTELY an unpaid claim for each date for each child.

Freda: You have two children?

Me: Yes, I do. Like I said, their names are Eli and Elsie

Freda: Oh, well they both have claims for each day, none were paid.

Me: But you JUST TOLD ME that the claims were all paid for those days in May for each child!?

Freda: Well, shoot. Sorry.

UGGHHHH!!! How in the world am I to have any confidence in the people handling my insurance claims when I have experiences like this morning with Freda? And how in the world is any person able to keep up with each claim for each child for each date without pulling their hair out between phone calls to providers and insurance?!

It takes a full-time job to do this, but I think insurance companies bank on people who just pay their bills without consulting the explanation of benefits pages and comparing them to the filed provider's claims. Some times the amounts are so off it is ludicrous! And there is never an explanation. I can't tell you how many HUNDREDS of dollars that we've been told we owe, only to find out the claim wasn't adjusted or filed correctly, and we shouldn't owe it at all!

The skinny of it is, just this morning our bill of $128 for the pediatrician has now been filed and will be paid in full, as it should have been. But not before literally more than an hour of phone calls. That should not be the way insurance companies handle customers.


Anonymous said...

Rusty's sister works for Kaiser Permanente in VA. You should hear how she describes the data processors there. No wonder we have so much trouble with Insurance co.'s. "Be peristent", is my motto. I've learned much over the years dealing with them.
Good luck.
I love seeing the blog on your sweet family.
Kathy D.

Scott and Malisa Johnson said...

Thanks Kathy! You're right about being persistent. I think insurance companies hope that we won't be. I only hope that I can learn to better deal with insurance! Right now all I do is get upset and frustrated!

The Nguyen Family- Sacramento California said...

I read this and couldn't help but laugh. I've been going back and forth with my insurance and the medical center that I had to go to for ultrasounds back in October and they sent me a threatening letter the other day for the balance. I called my insurance yet again and they said they were never billed. Then I had to call the medical center again and give them my ID number and everthing for the third time so they could bill my insurance. Finally... after months they got everything sorted and I didn't have to pay the $300.00 due for one ultrasound.