Insurance Runaround

This is a true story about why so many people are furious with health insurance companies.

I give my patients a superbill at the time of their visit in order for them to obtain reimbursement from their insurance company.  One of my patients sent in her form, correctly.  The insurance company asked for a copy of her records because they said the CPT code was not valid. (This code describes the type of visit.)  We promptly sent a copy of the records to the address on the envelope.  Then my patient received a notice that her claim was rejected  This morning my assistant spent one solid hour on the phone with the insurance company which included all the time she spent on hold waiting to speak with someone.  First the employee at the insurance company querried my assistant about the patient.  He read to my assistant the policy about billing units and codes.  (Please understand, I do not bill insurance companies because of the hassle and inconsistencies I have encountered over the years.)  My assistant explained that she did not understand what he was saying.  Then he noted that the patient’s records were sent to the wrong office.  (How are we supposed to know what office to send them to.  The request for records contained no address or phone number or letterhead, so we sent them to the address on the envelope.)  My assistant requested that the records be forwarded to the proper office.  The employee at the insurance company informed my assistant that they were not allowed to transfer records from one office to another.  My assistant then requested that the insurance company return the records to us.  He then stated that the records had been destroyed.  My assistant asked him if anyone would have been notified or would this claim just have sat there and delayed payment to the patient.  He said, eventually, a new case would have been opened under provider disputes where we would be asked for the records again.  He commented that we could mail the records to the correct office at which point, upon my assistant’s request, he gave her the address for where to send the records.  Here is the time table: the patient was seen early May.  The request for records came June 6.  We sent the records 2 days later.  The patient called us yesterday saying we needed to send the correct CPT code. 

My first reaction is to say “Aaaaaagh!!!”  This is what happens when people get caught up in rules and regulations because they are too afraid to truly connect with each other.  It also is a result of a company stating its purpose is one thing (namely, helping people) when all they want to do is make money and they don’t care who they step on to do so.

About Cathie Lippman, M.D.

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