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Pet Peeve: Insurance (continued)

So in my last insurance post I told you about the drama with my claims for therapy. Today I want to talk about my claim for rehab.

Before going to rehab I checked with my insurance to find out what sort of coverage I’d get. I was told that so long as I got pre-authorization I’d have my standard coverage. That meant that once I met my deductible they’d cover 70/30 of the allowed cost, and when I reached my out of pocket limit they’d cover 100% of the allowed cost.

Well, the rehab was really good about getting the pre-authorizations. First they covered two weeks and then it went on a week to week basis. I got the authorizations for my entire stay.

Once I got home, it did take time until I got the invoice from the rehab, but once I did, I promptly submitted it to AmeriHealth. I didn’t hear back from them for over a month. I had already gotten responses on my therapy claims that I had submitted after that claim (all of which were declined…). I finally got an EOB that stated I’d get reimbursed for about $14K. Seriously? Where in the world would they find a rehab for that price? But what can I do. They have their allowed amounts, and that would cover a portion of the loan I took out to go to rehab.

Time passed. I didn’t get any check. I called AmeriHealth a couple of times. Each time I was told that even though I got the EOB, the claim wasn’t processed and that I should call back in a couple of weeks. At some point I put my foot down. I gave the poor rep an earful. I was kind about it, though. I told her I understand that it’s not her mistakes, but that I needed to vent and she lucked out with picking up my call. I guess she felt bad. She looked into it and told me that the check had gone out over a month earlier. I then asked her who the check was made out to. Of course it was made out and sent to the rehab. I was ready to cry. I explained that I’m paying out on a loan with very high interest, simply because they are messing up. She then told me that I’d have to contact the rehab to get them to either issue me a check or to send it back to them so that they could reissue one to me.

That really took the cake. I put my foot down, with a real stomp! I told her in no uncertain terms that they made the mistake and that they would have to correct it. It’s unprofessional to pass the onus onto me when this is their fault. She tried to persuade me otherwise. I wouldn’t give. I asked for her supervisor. Instead she decided to contact the rehab herself. She couldn’t get through and told me she’d get back to me the next day. Of course I never heard back from her.

I decided to get in touch with the rehab myself. They told me that they did get the check and that they had sent it back. The problem is that my insurance only deals with snail mail and the rehab is in New Mexico. This makes the saga drag on even longer.

After another couple of weeks I called AmeriHealth again. They said that they didn’t get the check yet so they couldn’t reissue one to me. This rep got an earful too. I went through the whole spiel and explained that I needed to get the check right away. She told me she just needs to confirm with the rehab that the check was sent out. I told her that I’d wait on the phone until she got through to them. She came back a few minutes later and told me that they confirmed that they sent it back so she’d put a stop payment on the check and have them reissue the check to me this time. They did. Except that they sent it to the rehab again! Both the insurance and the rehab are claiming that they cannot make out the check to a client…

It’s high time I found myself a lawyer…

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