Insurance rant
Jan. 8th, 2007 04:00 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
same_skyI just spent forty minutes on the phone with a fine representative of the insurance company. I am appealing their decision to deny my prescription drug coverage for a medication prescribed to me to help me sustain my pregnancy in the first trimester. At least, that was why I called. I became further alarmed when as it turns out, he has no records for me for the entire year last year. None of the medications that they paid for, none of the attempts by the pharmacy to process this particular prescription, none of the prescription numbers, NOTHING. He searched by my ID number, by my SSN, by my name, and found not a single entry. There were no notes from my last call in October. There was, frankly, nothing there to indicate that I was a member of my insurance company's prescription drug plan. He reboots his computer, hoping to find something brand new when he logs in again. There were suggestions that I must have changed my name, registered under the wrong SSN, was covered by multiple plans, had called the wrong company for reimbursement. There was not even a record of them denying my claim to begin with. He couldn't even find the medication in his database. His solution? Have my HR company call them and request an override since my plan does not cover this medication.
(Is it a good time to point out that this same medication has been covered by the plan THREE TIMES in the past? Once by the same pharmacy, same prescription number? Yes?)
I carefully explain to this shining example of helpful service that perhaps I am quite concerned that calling my HR department, explaining my medical needs and requesting that they call the pharmacy line back would be perhaps, unsuccessful, if indeed there was NO RECORD OF ME EXISTING IN THEIR SYSTEM other than an empty database record. I mean, what? Our HR department is lovely, truly lovely, but if they call in a request for an override, they are going to say "Kisha who? What the heck are you talking about? There was no claim denied! This person isn't in our system!"
He did not understand the growing note of hysteria in my voice. I am, at this point, becoming less concerned with the fact that they're keeping a hundred dollars from me than I am the fact that THEY HAVE LOST MY MEDICAL RECORDS. I mean. Hello. HIPAA? Why is this man not alarmed?!
So, he puts me on hold to "talk to another department" about this. When he returns, he fill me in on a big secret.
He was unaware that he needed to look back at 2006 for all of these transactions that I'm referring to.
Because, you know. Just because I gave him dates from last year, and just because it is the eighth of January and therefore, there hasn't been TIME for me to submit any sort of claim form and get it denied in the four business days last week... how could he have known how to look at the records for last year? That's crazy, man.
(The end result, because I hate being left hanging on these things, is that I need to write an appeals letter. I was so worn out by this time that I gave up and agreed to write the letter just to STOP TALKING TO THIS GUY.)
I have utmost faith that they will properly handle my medical needs in the future. Yay, health care!
(Is it a good time to point out that this same medication has been covered by the plan THREE TIMES in the past? Once by the same pharmacy, same prescription number? Yes?)
I carefully explain to this shining example of helpful service that perhaps I am quite concerned that calling my HR department, explaining my medical needs and requesting that they call the pharmacy line back would be perhaps, unsuccessful, if indeed there was NO RECORD OF ME EXISTING IN THEIR SYSTEM other than an empty database record. I mean, what? Our HR department is lovely, truly lovely, but if they call in a request for an override, they are going to say "Kisha who? What the heck are you talking about? There was no claim denied! This person isn't in our system!"
He did not understand the growing note of hysteria in my voice. I am, at this point, becoming less concerned with the fact that they're keeping a hundred dollars from me than I am the fact that THEY HAVE LOST MY MEDICAL RECORDS. I mean. Hello. HIPAA? Why is this man not alarmed?!
So, he puts me on hold to "talk to another department" about this. When he returns, he fill me in on a big secret.
He was unaware that he needed to look back at 2006 for all of these transactions that I'm referring to.
Because, you know. Just because I gave him dates from last year, and just because it is the eighth of January and therefore, there hasn't been TIME for me to submit any sort of claim form and get it denied in the four business days last week... how could he have known how to look at the records for last year? That's crazy, man.
(The end result, because I hate being left hanging on these things, is that I need to write an appeals letter. I was so worn out by this time that I gave up and agreed to write the letter just to STOP TALKING TO THIS GUY.)
I have utmost faith that they will properly handle my medical needs in the future. Yay, health care!
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no subject
Date: 2007-01-08 09:04 pm (UTC)no subject
Date: 2007-01-09 06:51 pm (UTC)no subject
Date: 2007-01-08 09:13 pm (UTC)Good (more than just a breathing body) customer service people are far and few between. Unfortunately.
no subject
Date: 2007-01-09 06:51 pm (UTC)no subject
Date: 2007-01-08 10:06 pm (UTC)Still it is somewhat comforting as well as annoying to know that incompetence is a global talent.
no subject
Date: 2007-01-09 06:53 pm (UTC)I think incompetence is truly global, but if we were going to have a a global talent, why couldn't it be something like... kindness, or good table manners?