It is 2:53 and I have just now returned from my 11:40 appointment with the cardiologist. It was only about 20 miles from here, so drive time doesn't really account for much of the time. It was only a consultation. He ordered more diagnostic tests to be done next week. So, you may be wondering why it all took so long?
I will tell you. Insurance. We are currently enrolled in a market place plan through United Health Care (aka Obama Care). Every year, you have to reapply and renew or change your plan. We stayed with pretty much the exact same plan. Same numbers, etc. on the new card. We paid the premium on February 1, 2016. Our account shows that the money went to them on Feb. 1st. Today is the 12th. So, imagine my profound irritation to be told that my insurance rejected my visit.
When she tried to confirm coverage, it came back, "rejected" with a code. Instead of just sending me home or giving me the option of paying out of pocket and fighting with the insurance company later, the office manager called them. She was told that payment had not been made and she relayed that the patient (me) insisted that it had been made and that the money had been drawn from her account. "Well, maybe it hasn't been posted yet."
By now, my appointment time has come and gone, been given to the next patient. The office manager is my new best friend! She goes the extra mile and asks to speak to someone who has the ability to fix the problem. She dutifully writes the number down, then asks what extension and how many different people she will be referred to before she will actually reach the right person. This gets her an offer to transfer. And she starts talking to Mike.
Mike is a little snarky and you can tell from her side of the conversation that he is indicating that we really didn't pay the premium. She insists that we did and then he tells her that it might be just waiting to be posted. She questions why it would take 12 days, nearly 2 weeks to post a payment. He wants to talk to me. The connection is not good. Sounds like he is on his cell outside. He asks me if I have filed a claim this year and I say no. He says that he asked me if I had made a payment. Maybe I misunderstood, but I don't think I did. He says, "Well that's your problem." I ask why I am paying premiums, and this is when he tells me I told him I have not paid. HeWho took the phone from me at this point.
I am proud to say that HeWho kept his cool and did not ask Mike when he would be pulling his head out of his a$$. Mike kept insisting that we had not made any payments since December when the policy was renewed. HeWho offers to make a payment right then in order for me to be seen, saying they could apply the balance (when they found it) to the next month. Lo and behold, Mike suddenly finds the payment(s) for the past two months just hanging out there in computer land!!
Mike gets to talk to the office manager again. In a very calm and friendly tone she tells him that he needs to resolve these issues and let the people in charge of posting payments know that this is a very real problem that had a domino effect on everyone involved. She goes on to explain that the wait to post payments is not exceptible and that someone is not doing their job. She was very nice and I could hear his voice on the other end. He was not happy. He then asks her to wait to file the claim and she refuses, telling him that they comply to all standards set forth by the insurance companies and the policy is to file the claim electronically at the time of service and that she expected him to handle it on his end ... "this claim better not be rejected."
Did I say that I love this woman? I have more tests ahead of me. I have a stress test scheduled at the hospital next Friday, then I will get the halter monitor to wear for two weeks. He says my heart is irritated about something (so am I). After the results of the stress test he said he might order a sleep study to see if I am getting enough rest when I sleep. He says that the PVC's could be the culprit of the bad sleep .... or the bad sleep could be causing the PVC's. After having some blood drawn, we headed home. I am so tired. I see a nap in my near future.
5 comments:
Give that woman a medal and a raise. It seems she is used to dealing with the twenty somethings now running the world. Perhaps then you could send her round to my doctor's office, where the actual staff need smacked.
I am so pleased that you had that woman and HeWho to fight for you! Insurance is a racket. They want to take the money, but not dispense the money.
We went through that at work a year ago with Coventry Health Care of Missouri. Every single employee had problems with them, as did my niece, who works at a neighboring school that was in our consortium, using the same insurance.
Lately I have been dealing with the medical offices themselves. They love to double-bill, and leave it to me to order the canceled check and fax it to them to prove payment.
Gosh Kathy .. what an incompetent insurance outfit.
How stressful is that?
We are lucky to have our NHS but even tat sucks sometimes.
Hope your issues are resolved soon.
Popped over to have a peek at your other interesting blog . . . :)
Cheers
Eddie
Glad that the story had a happy ending, but it stinks that you had to work so hard to get there. Youngest Son has insurance on the exchange, too. I get involved as little as possible, but it doesn't sound like it's been completely smooth.
well, yay for her. so rare to find someone willing to resolve issues instead of just pass them on. I have United as my supplement to Medicare and so far I have no complaints with it.
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