Their Lack Of Professionalism Is An Eye-Sore

, , , | Healthy | October 27, 2017

(My eye insurance changes when I got a new job, so I need to find a new doctor for my contacts exam. I choose one in the same building as my previous job at a pharmacy, as I’ve met [Doctor], who is a really nice guy, and call to make an appointment.)

Me: “Hi, before I make an appointment, I want to confirm that you take my insurance?”

Receptionist: “Oh, the plan offered by the local hospital? Of course we do.”

(I’m scheduled for the next open appointment, three months away. Fast forward to the day of the appointment. She copies my insurance cards, and I wait for my exam.)

Nurse: “[My Name]. Good afternoon, the doctor will be in to see you shortly.”

(In walks a short, bald, bearded man, not the tall, thin, bespectacled fellow I knew from the pharmacy, but I figure perhaps [Doctor] has expanded his practice or has a fill-in today. He proceeds to do my exam and tells me my script will be up front, no niceties, no introduction.)

Me: “Thank you! And I’m sorry, but I didn’t catch your name.” *primarily so I know not to schedule an appointment with him again*

Doctor: “[Doctor], of course!”

Me: “Oh, I apologize. I mistook the taller gentleman with glasses for you.”

Doctor: “He’s just the optician.”

(Cue the end of the awkwardness, and I go up front to pay my copay and get my script.)

Receptionist: “That will be [amount nearly $300].”

Me: “What? Shouldn’t it be $50 with my insurance and deductible?”

Receptionist: “Oh, we only take your insurance for eye emergencies.”

Me: *pays with mouth agape*

(She knew they only took my insurance for emergencies and scheduled me for an obviously non-emergent appointment. Then she copied my cards, again not pointing out that it wouldn’t cover my visit. And the doctor was an unfriendly, cold fellow to boot. Needless to say I never went back, even though my insurance has now changed to something they universally accept.)

Will Never Claim Ignorance

| San Antonio, TX, USA | Working | April 16, 2014

(My daughter has had an insurance claim denied due to pre-existing conditions. She had an allergic reaction to a routine vaccination she had the previous day. I work as a claims processor for the company we have our insurance through. I even process employee claims on occasion, and I know all the rules and regulations for pre-existing conditions as they apply to our insurance plan. I call the company to find out why they denied this claim.)

Me: “Hi. I’m calling to find out why you denied my daughter’s claim.”

Customer Service Rep: “Okay. It looks like it was denied for being a pre-existing condition.”

Me: “Yes, I know it was denied as a pre-existing condition. I’m trying to figure out why it’s a pre-existing condition. You see, I also work for this company and process claims like this on a daily basis. I know that there are certain CPT codes that are supposed to be looked at for pre-existing conditions. I also know that before a claim is denied for being pre-existing, the processor is supposed to research through the member’s history to see if there are any related claims that have been denied or paid or have documentation attached to prevent denial. I also know that if the processor had done their job correctly, that they would have seen a routine doctor’s visit the day before and would have made the connection between the vaccination and the allergic reaction. Plus, I also know that allergic reactions are not considered pre-existing when there are no other claims in the member’s history for a similar reaction. And now, the most important point: according to California law, pre-existing conditions can only apply for the first six months a member has a plan with a health insurance company. I have been employed by this company, with full benefits, for over a year and a half. There is absolutely no reason that this claim should have been denied.”

(There is extended silence.)

Customer Service Rep: “Oh. Okay, we’ll get that fixed and paid as soon as possible!”

(The claim was paid and I never had a problem with the company denying any claims for pre-existing conditions again!)

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Just Say The Magic Record

| USA | Working | February 23, 2013

(I have two health insurance plans. My pharmacy will file for the primary plan but not the secondary. So, I file it every six months. To do so, I need an Explanation of Benefits (EOB) from my primary insurance. Getting one is always harder than pulling teeth.)

Rep: “Thank you for calling [insurance company]. This is [name]. How may I help you?”

Me: “Hi, I am needing an Explanation of Benefits (EOB) from January 1 to June 30th, and I need to speak to a supervisor.”

Rep: “I am sorry, ma’am; we cannot do that.”

Me: “Melissa, I know at your level you can’t. That’s why I need to speak to a supervisor.”

Rep: “Yes, ma’am. How may we help you?”

Me: “I am needing an Explanation of Benefits (EOB) from January 1 to June 30th, and I need to speak to a supervisor.”

Rep: “I am sorry, ma’am; we cannot do that.”

Me: “I know at your level you can’t; that is why I need to speak to a supervisor.”

Rep: “Yes, ma’am. How may we help you?”

(This actually went in circles for a few times, with the rep sounding more condescending and really enjoying herself. In frustration, I hang up, fuming. Ten minutes later, I call back. I get the same rep again. First sentence and she is already enjoying herself.)

Rep: “Thank you for calling [insurance company]. This is [name]. How may I help you?”

Me: “Hi, I am needing an Explanation of Benefits (EOB) from January 1 to June 30th, and I need to speak to a supervisor.”

Rep: “I am sorry, ma’am; we cannot do that.”

Me: “I know at your level you can’t that is why I need to speak to a supervisor. And there is another thing I know. I know: I am RECORDING this, and I need to speak to a supervisor.”

Rep: “Yes, ma’am!” *transfers me immediately*

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