Fun With Health Insurance

We have a claim from 2006 that still hasn’t been paid by the insurance company. My wife had an ingrown toenail that needed to be fixed as it was causing an infection in her toe. So she went in to the doctor, got it taken care of and that was it. Well 6 months later we get bill for the full amount. So I call the Doctors office. They say that Blue Cross rejected the claim but doesn’t know why. So I then call Blue Cross. They say that the doctor submitted the claim as “Cosmetic” and that they don’t pay cosmetic claims. So I ask them what needs to be done to fix this. They tell me that the doctor’s office needs to resubmit the claim as “Medical”. We call the doctors office and tell them what BlueCross said. They agreed to resubmit the claim, telling me that they were sure they submitted it as “Medical” the first time, but of course no one wants to actually research this for me. Sounds simple enough right?

Wrong! 6 months later we get the same bill again. No changes.  At this point we figured everything was paid for, so I immediately call Blue Cross again. They tell me that the doctor’s office has not resubmitted the claim since we last spoke to them 6 months earlier. So I hang up and call the doctors office back. They say they submitted the claim again to Blue Cross 6 months ago after we talked and it was rejected again.

 So my question is, who is lying here? I tend to believe Blue Cross as they pretty much log every call and claim that they receive for legal purposes. It is very frustrating to play the middle man in all of this when I can never get them both of them on the phone at the same time and someone is obviously lying to me. So where we left it is that the doctor’s office was going to submit the claim yet again.

Well guess what. Just got the bill yesterday for the full amount again! In about an hour I am plannig to do a 3-way conference call with both of them since I am so fed up with this as they obviously can’t do their jobs correctly. Yesterday, I also drafted a letter to both of them explaining this stupid process and how I am unhappy with the service from both of them. Since this is health care, no one will probably even care. But it does start to show me why the health care process is such a mess. I am thinking about starting up a company as a mediator between the insurance company and the doctors office as I am sure other people have to deal with this kind of crap as well.

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