Did i mention I HATE insurance companies?

[mudnuri]

DBF had oral surgery on April 21st. The surgeon I took him to does not accept insurance. HE will fill out any paper you want for your claim, but his office does not accept it- for the reason- I had 4 teeth removed a few weeks earlier- to the tune of $3200. DBF had 8 teeth removed (from a tree in the face accident) to the tune of $650. Both of us had general anesthesia.

Anyway- on that day- while DBF was in surgery- I called the insurance company to make sure I had the form filled out correctly- the lady said- it would take approx 30 days to process the claim and for him to receive his check. K sounds good...

Wednesday- I decide to call the insurance company to see if they have received the claim. no record of it. Lady was quite snotty with me on the phone when I started pushing the issue- finally she said- 'your not the policy holder, I dont have to tell you anything" to which I replied- your right I'm not- but I am authorized to speak to you on behalf of the policy holder- look at the paperwork. (i was right....I am authorized..)...

Anyway- she tells me to fax it in. Um- you have it...

DBF gets home from work and I'm fuming- so he calls them- SAME lady- (he's got her on speaker- and how many Aretha's do you think work at RMSCO?) Tells him it can take 2-3 weeks to be input into the system- give it a few more days- if not by the end of next week- fax a copy in.....um end of next week- that'd be the 19th, pretty darn close to 30 days right?

So DBF calls the surgeons office- tells him what happened and the surgeon says- "now you know why I wont accept insurance"...yup now we do! We faxed the surgeon another dental form- he filed it out AGAIN and faxed it back to us- i faxed it to RMSCO, the ## Aretha gave me, and now am being told- call back in 48-72 hours to see if it's been received- um...no how bout you walk your little but over to the fax machine- and see if its there!

JERKS! I said to ARETHA.....your pretty quick to send your bills or your denials- what would happen if I told you "call back in 2-3 weeks and I'll see if your bill has come in?????"....yeah- thats what I thought...CLICK

Brandy

 

[kirbsam]

the insurance industry is arrogant, and not working in the patients best interest for the most part. it is there job to make money. they do that by denying claims and delaying paying on claims, so they can make millions of dollars in interest, while doctors and patients continue to lose out. look around at the huge buildings and expansive lands and incredible landscaping that insurance companies have. they build these things on the premiums people pay, and the money that they dont pay out. it reminds me of las vegas, when people say how can these casinos keep building these taj mahals. it is because nobody really wins in vegas except the casinos.

 

[bicker]

That's not arrogance: It is fiduciary responsibility. It's the law.

I wouldn't be so envious of those nice buildings. They project a message of stability, which we customers reward insurance companies for projecting. Inside are normal people, just like you and me.

 

[AllyandJack]

Oh, I've had many disagreements with my insurance company. If I actually get a real answer from someone, I tell DH that I got to talk to the person who got to use the brain that day. In any business, you have employees who are good and employees who are not so good. I actually lucked out two phone calls in a row and got the person with the brain on that day. Keep calling until you get someone who knows what the heck is going on. I'd say ask to speak to a supervisor, but I tried that. I got put on hold and told, "I just asked him. He agrees with me."

 

[California Girl]

just out of curiousity, why did you go to an oral surgeon who doesn't accept insurance. if you had the choice? my insurance list doctors who are participating. we are warned that if we use someone outside the program there are limitations. it's not an hmo. it's just some choose to participate and some don't. that way the headache's theirs.

 

[llp479]

Send the claim via Fed Ex or registered mail. That way you have proof of receipt. Most states have laws that require a claim to be processed in a certain number of days. That way when they claim they don't have it, you can say so and so signed for it on such and such date.

If you continue to have issues, ask for a supervisor and tell them you will be contacting your state insurance commissioner if the issue isn't resolved in X number of days. That usually gets them moving.

 

[Obi-Wan Pinobi]

just out of curiousity, why did you go to an oral surgeon who doesn't accept insurance. if you had the choice? my insurance list doctors who are participating. we are warned that if we use someone outside the program there are limitations. it's not an hmo. it's just some choose to participate and some don't. that way the headache's theirs.

That's what I was wondering. With the costs involved I would never risk going out of network for oral surgery. Too much of a chance you will get zip in the end.

 

[mickeyboat]

Brandy lives in the same area of the country that I do, and we definitely have a more limited number of choices when it comes to professional services and insurance networks. Also, when you find someone you are comfortable with, you tend to want to stick with them. There is a dermatologist in town that everyone loves, but she does not participate in any major insurance networks. Many people still choose to go to her, anyway.

Good luck in getting your claim resolved. Is your DBF's policy through his work. Talk to the benefits administrator at his work, and see if he or she can put you in touch with their insurance agent. I have found agents very helpful in getting issues like this resolved.

Denae

 

[Disney Doll]

I'd be making a call to Aretha's supervisor and mentioning the Insurance Commissioner, if I were you.

 

[mudnuri]

just out of curiousity, why did you go to an oral surgeon who doesn't accept insurance. if you had the choice? my insurance list doctors who are participating. we are warned that if we use someone outside the program there are limitations. it's not an hmo. it's just some choose to participate and some don't. that way the headache's theirs.

Sorry I forgot that part in my OP-

DBF's dental insurance is open, meaning he can go anywhere. His company is based out of PA, and up here in VT/NH there are VERY few dentists/surgeons who will take the insurance. We are open to go wherever we want- and pay out of pocket- then are reimbursed up to $1,000 in the calendar year. We could not find an oral surgeon who would accept the insurance, therefore we had to go with the guy who was $650. If I had brought him to mine, we still would have only been covered up to 1,000 and the rest we would have to pay out of pocket. The dental coverage max's at 1,000 a year regardless of who accepts it or doesnt.

That is why I chose the surgeon, the price, and the fact that he offered general anesthesia....I knew we would have to wait for reimbursement- again- another reason we went with this guy- we could 'afford' to wait for 650, can't 'afford' to wait for 5K plus.

Brandy

 

[mudnuri]

Brandy lives in the same area of the country that I do, and we definitely have a more limited number of choices when it comes to professional services and insurance networks. Also, when you find someone you are comfortable with, you tend to want to stick with them. There is a dermatologist in town that everyone loves, but she does not participate in any major insurance networks. Many people still choose to go to her, anyway.

Good luck in getting your claim resolved. Is your DBF's policy through his work. Talk to the benefits administrator at his work, and see if he or she can put you in touch with their insurance agent. I have found agents very helpful in getting issues like this resolved.

Denae

I called HR today- and left a message for the woman who deals with the dental benefits. Awaiting her call back.....its just hard being that the company is world wide- and headquartered in PA...the GF's up here are not familiar with the benefits!

Brandy

 

[luvthatdisney]

Well I worked for 13 years in the medical/dental industry - until I was laid off (was a good thing imo!!). Anyway, at the company I worked for - here are the initials - I'll let you figure it out - MOO - we had 10 working days to enter a claim from the time it is received by the mailroom and date stamped. That was the companies time service rule for our office and plans.

Now if the claim was to be faxed to a customer service rep then they could fax it to a specific fax number and the rep could get up and get it - right by their desks. It would then have to be routed to a claim team for entry and payment - that could still take up to 10 days - but usually faxed claims were processed within 3 days.

As you can see all insurance companies do not have the same policies or procedures. I felt we gave good service and went out of our way to help our customers, but I am sure some of the customers did not feel that way.

Please remember to always make copies of your claims and any related paperwork. Start a file for just that. Things can get misplaced or lost in the mail - we have had lots of mail destroyed by the post office - by accident!! So you never know what might happen to it - rather be safe than sorry!

Hope that helps!

 

[luvdzne]

I have been battling my insurance co. for months now. I wish I could send them the bill for all the time I have spent on the phone with them having them fix THEIR errors . Sometimes I think they don't even know their own policies