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Insurance Co./hospital frustration
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 2006-08-30 12:58 PM |
Master  1914    Finally north of the Mason-Dixon Line |  Subject: Insurance Co./hospital frustrationI have to VENT!!!! I had my youngest child 1 yr ago - Aug 25... I'm still fighting with the hospital and insurance company. Noone wants to step up and take personal responsibility in regards to getting this claim settled. The insurance company processed claim wrong - they paid it as out of network when hospital was an in-netwark facility - so in order for that mistake to be corrected the hospital has to re-pay what the insurance overpaid - but the hospital claims 6 refund letters have yet to be received even though insurance company has received verbal confirmation that all 6 have been received. I don't understand why businesses/supervisor SOMEONE can not take a personal responsibility effort to see that this is corrected. It's been a year for crying out loud! Where is responsibility where is customer satisfaction where is taking pride in job well done and seeing things thru? For a year I have been dealing with this. I think I have spoken to every person at Cigna and every person at the hospital - yet noone is willing to see that this is corrected and I receive my money back from the hospital for overpayment. I rec'd. a verbal statement from a supervisor at the hospital today that she'll take care of things, but I've heard that so often that I have little faith she'll actually do it. If she does, God Bless her, but I'll believe it when I see it! Side note - I do like my insurance company overall. they have been more then helpful in paying for my son's speech therapy (they really don't have to but given his speech severity they have choosen to cover it). it's just this 1 claim that has been a boil on my back side! UHGGGGGG! I'm so pissed and annoyed.... another day shot to h--- with this anger. I know I should just write off the $500+ but it's $500+ and I have a baby in diapers and 2 in school who need new clothes, school supplies etc... $500 can go a long ways for me. Anyone else with this kind of personal annoyance with hospitals and insurance companies? cathleen Edited by houston-tri-mamma 2006-08-30 1:00 PM |
| 2006-08-30 1:08 PM in reply to: #526900 |
Elite 2673  Muskego, WI | Subject: RE: Insurance Co./hospital frustration I am a health insurance agent so I get involved in this type of thing all the time. Is your agent or the agent that put it in place with your company involved? I have driven letters like what you speak of over to the local hospital and made them give me a receipt in writing on behalf of clients. FWIW I've also seen clients give up and 3 years later during an audit of some kind the hospital sends them a check. Amazing.
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| 2006-08-30 1:29 PM in reply to: #526900 |
Master 1914 Finally north of the Mason-Dixon Line | Subject: RE: Insurance Co./hospital frustration Our HR doesn't have it act together any better then the hospital. That's a whole nother matter though. they are of no help in this situation. I have even offered for the insurance company's third party who send these letters to mail it to me and I would hand deliver it. Nope no their policy for me to receive such mail. We'll see what happens this week if anyone take responsibility and this matter is resolved. Edited by houston-tri-mamma 2006-08-30 1:30 PM |
| 2006-08-30 1:53 PM in reply to: #526900 |
Extreme Veteran 351 Seattle | Subject: RE: Insurance Co./hospital frustration I would send them a certified letter with a timeline and CC the state insurance commissioner and the health plan. There is nothing that strikes fear in the heart of a facility than the threat of an audit. You can also request that they pay you interest on your refund amount. They would certainly charge you late fees if you didn't pay them. And most insurance contracts state that they have to pay the carrier interest if they fail to send in a refund check in a timely manner. You deserve to get your money back. And they should take care of you promptly. $500.00 is a big deal, and it's your money. I work in the billing office of a medical practice. We have had so much more success getting responses to our appeal letters now that we send them certified. They cannot pull the "we never got your letter" crap. We have a signature that says they Did get it, and they have a specific period of time in which to respond. |
| 2006-08-30 2:16 PM in reply to: #526973 |
Elite 2673 Muskego, WI | Subject: RE: Insurance Co./hospital frustration la_guerita - 2006-08-30 1:53 PM I would send them a certified letter with a timeline and CC the state insurance commissioner and the health plan. There is nothing that strikes fear in the heart of a facility than the threat of an audit. You can also request that they pay you interest on your refund amount. They would certainly charge you late fees if you didn't pay them. And most insurance contracts state that they have to pay the carrier interest if they fail to send in a refund check in a timely manner. You deserve to get your money back. And they should take care of you promptly. $500.00 is a big deal, and it's your money. I work in the billing office of a medical practice. We have had so much more success getting responses to our appeal letters now that we send them certified. They cannot pull the "we never got your letter" crap. We have a signature that says they Did get it, and they have a specific period of time in which to respond. This is VERY good advice. If a facility fears an audit, the insurance company fears the state commissioner of insurance's office. All I'd add is that the state insurance commissioner's office likely has a formal complaint procedure, and just cc:'ing them on a letter isn't enough to get that started. Put a timeframe in your letter and if that date arises, contact the state insurance commissioner again and begin the FORMAL procedure. |
| 2006-08-30 2:31 PM in reply to: #526900 |
Master 1914 Finally north of the Mason-Dixon Line | Subject: RE: Insurance Co./hospital frustration Good advice. When I submit claims for re-imbursement I also send cerified returned receipt etc..... in this case, the insurance party's third party "accent" is responsibile for writing, mailing and receiving these refunds. Accent will not deal with me period. I have gotten the insurance people though to get them to fax this letter - even though it's "against their policy"- since the snail mail has failed. Seems like the insurance agency also doesn't really care that they are not receiving their own refunds. Then again they have money and $251.39 isn't much to them (that's what they are owed from the hospital). If this fails - rather this supervisor fails me - I will get the state insurance people involved because I'm just fed up. Thanks for listening to my rants! |
| 2006-08-30 8:55 PM in reply to: #526900 |
Extreme Veteran 309 | Subject: RE: Insurance Co./hospital frustration I work with insurance companies all the time. Here are the things that I have found most effective: 1. Always send correspondance return reciept requested. 2. Whenever I speak with someone, I ask for thier name. 3. After two calls about an issue, with no change in the status of the claim, I say these words," May I speak with your supervisor?" 4. If something goes unresolved for more than ninety days, I would send letters to the head of the insurance company for the state, ( i.e. President, Cigna of Texas, etc.) and carbon copy the letters to the following: State insurance commisioner, Hospital administrator, and the Head of Claims resolution for the insurance company. I also send copies of all paperwork pertaining to the claims, highlighting the errors. Oh, yeah. And whenever someone tells you something will be resolved, ask for it in writing. Also ask them the date they expect the claim to be resolved. I will say something like," For my records, could you please put that in writing? Can you tell me what day we can expect to have this resolved?" If they refuse to put it in writing, go straight to the big-wigs, because someone is lying.... Good luck with this. Edited by JoyfullySo 2006-08-30 9:00 PM |
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