Monthly Archives: January 2012

Healthcare Providers and Insurance Companies

Did you know that when an insurance company makes a mistake involving an overpayment to a healthcare provider, the healthcare providers are required by law to report that overpayment?

I discovered an error and reported it.  The insurance company reprocessed the claims they had denied; however, the secondary insurance company had already stepped up to the plate and acted as the primary insurance company and paid the claim.  Meanwhile, the healthcare provider had been paid by both insurance companies and were still sending me an invoice for the difference between the amount charged and the allowable fee.

When I tried to inform the insurance company that the healthcare provider had collected double (sometimes more) the amount owed, I was informed that it was the healthcare provider’s responsibility – they are required by law – to report the overpayment.  the insurance company was NOT interested in the information I had to offer.  Amazing!!

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Insurance Companies

Lately I seem to have had my unfair share of dealing with incompetent insurance company representatives.  Even though this information is the gospel truth, I don’t know what legal ramifications are involved with naming names, so we’ll call the insurance company “ABC Corporation” (ABC).  In August 2010, there was a mix up with payment of my premiums.  I discovered the problem – ABC incorrectly filed my payment – and the balance due now showed the corrected amount due moving forward.  However, when I changed insurance companies to “DEF Corporation” (DEF) and no longer needed ABC, I received the Proof of Insurance form from ABC and it had the dates of coverage wrong.  It showed my coverage ending on 3-31-11 instead of 4-30-11 – one month too early.  Unfortunately, I didn’t realize this error until I started received medical claims that were denied.  I contacted the people who helped me resolve the premium problem they  promised to notify ABC and have them reprocess the claims. The problem now is that the secondary insurance company (DEF) became the prime insurance company when the prime (ABC) denied the claims.  Now that the error has been corrected, I was in contact with all parties and each time I spoke to someone, I was told something different.  This went on between the date of services, which was 4-27-11 through January 2012 when I’d finally had enough of dealing with both insurance companies and the healthcare providers.  Meanwhile I was starting to receive notices from the healthcare providers that they were going to send my account to the collections agencies.

So I wrote a letter.  I had kept detailed notes throughout all these conversations so, in my letter, I named names, dates, and all details. I told the insurance company what I expected and what I wanted.  Within one week, I received a phone call from a representative of ABC and she was knowledgeable, thorough, and very helpful in providing me with all the information I needed to resolve the issues with the healthcare providers and with the secondary insurance company.  When you do this, you need to:

– Be professional (if you appear irrational the company will NOT take you serious). However, there is no reason you can’t let them know how angry, frustrated, etc. you have become due to the lack of whatever it was that cause you to have to write this letter in the first place.

– State what you want and expect the recipient of the letter to do as/provide what you ask.  Blowing off steam is good when you’re talking to your best friend, but the point of writing a letter should be, at a minimum, to correct the wrong not to call the customer service representative that hung up on you three times an idiot.  Also, don’t be unreasonable in your expectations – a business that changes the oil in your automobile will NOT buy you a new car if there were no residual damages as a result of them leaving the cap off the oil pan, but if they want to keep you as a customer, they might give you free oil changes for six months.  Bottom line is:  don’t be afraid to ask for a reasonable “settlement.”

I told the insurance company what I expected and what I wanted.  Within one week, I received a phone call from a representative of ABC and she was knowledgeable, thorough, and very helpful in providing me with all the information I needed to resolve the issues with the healthcare providers and with the secondary insurance company.