Right Working Romantic Related Learning Friendly Healthy Legal Inspirational Unfiltered

When They Act Tough, You Call Their Bluff, Part 2

, , , , , , , | Working | November 22, 2022

When my baby was six months old, the pediatrician’s billing service sent a notice saying the insurance company refused to pay for one of his well-visits. Since it should have been covered, I called the insurance company first.

Insurance: “It’s a network thing. You needed to get a referral from the primary care doctor first.”

Me: “But we saw the primary care doctor.”

Insurance: “The claim says you visited an anesthesiologist in [Town #1].”

Me: “Uh, no. We went to the pediatrician’s office in [Town #2].”

Insurance: “Oh, I see the problem. The healthcare network’s billing agent reversed two of the numbers in the billing code. They put in 123456, but they should have input 123465. Have them resubmit the bill, and we’ll pay it.”

I called the billing center and explained the problem and that if they resubmitted the bill, they’d get paid.

Agent: “No.”

Me: “No?”

Agent: “I already submitted it, and they rejected it.”

Me: “You submitted an incorrect claim, and that’s why they rejected it.”

Agent: “It’s been submitted and rejected, and now you need to pay for the visit.”

Lather, rinse, and repeat for about two minutes.

Me: “Okay, well, have a nice day.”

I hung up, brewed myself a nice cup of tea, and played with the baby for a while. Feeling refreshed, I called the billing center back. I got the same agent.

Me: “Hi! I called before about an incorrect bill you submitted to insurance.”

Agent: *Huge sigh* “There is nothing I can do about it.”

Me: “Well, I’ve turned you in to the state insurance commission for insurance fraud.”

Agent:What?!

Me: “They said they’ll call in the next couple of days.”

Agent: “Why would you do that?”

Me: “Because you billed my insurance company for a visit to an anesthesiologist in [Town #1] that my son never went to.”

Agent: “But you—”

Me: “My son never had any surgery or any medical condition that would require an anesthesiologist. I can prove quite thoroughly that I had nothing to do with this doctor.”

Agent: “Are you serious?”

Me: “Finally, I can prove I wasn’t there because at exactly the same time you claim I was receiving services in [Town #1]… I was in my son’s pediatrician’s office twenty miles away.”

Agent: “Why are you doing this?”

Me: “By insisting my insurance should pay for that visit, when you know I was never there, that’s insurance fraud.”

Agent: “…”

Me: “…”

Agent:Fine. I’ll fix the claim!”

Me: *All sunshine* “Thank you!”

The minute the corrected claim arrived, insurance paid up.

Related:
When They Act Tough, You Call Their Bluff

Question of the Week

Has a customer ever made an impossible demand? Tell us your story!

I have a story to share!