Pet Peeve: Insurance (Any surprise in that?)

It’s official! Insurance is just a scam.

OK. I’ve just about had enough. This is the saga of the 2015 mess of insurance.

When I got my last two jobs, when it came to getting health insurance, I took out a private policy. The first place wasn’t big enough to require offering insurance (and they didn’t), and my current place doesn’t offer out of network coverage on their insurance plan. So I bought a private policy. It’s how I pay for therapy. I could never go for therapy otherwise.

Well, I don’t know if you’ve heard, but there’s this “healthcare reform”. And a reformation it most certainly was! Aside from all that¬†changing, my insurance company (AmeriHealth NJ) decided to revamp their system for 2015. I didn’t think anything of it. My therapist took care of the billing codes, and as far as I was concerned, they had been paying out on my therapy claims for three¬†years already. I didn’t expect any trouble.

Boy was I wrong. I started submitting my invoices for reimbursement. Now, realize, though we are in the 21st century, my insurance requires all claims be submitted by snail mail. Once the claim reaches them, it takes 2-4 weeks until it’s processed, and an additional couple of weeks to get the response. So each time anything is submitted, there is a lag of at least a month. Each time I get on the phone with them, it is for a minimum of a half an hour, but, on average, it’s about an hour. Also, they don’t give out direct phone numbers or emails for reps, so each time I call I have to repeat the saga to a new rep.

All claims starting as of January 2015 started coming back declined. When I called the insurance company they told me to appeal the denial. I did, and they were denied again. I called again and they told me to resubmit them. I did. They were denied and I appealed again. They were denied, once again.

I called them again. This time they told me that they were being submitted to the wrong place. Apparently, mental health claims need to be submitted to a sister company, Magellan. And so I did. But they were declined there too. I was getting really exasperated. I called Magellan. They told me that the claims needed to be submitted to AmeriHealth, not them. They only take care of in-network mental health claims. Out of network needs to be submitted to AmeriHealth. Before submitting them again to AmeriHealth I called them to check out where I was supposed to send it. They told me that the rep that told me to send it to Magellan was mistaken, and that it should, in fact, be sent to AmeriHealth.

And so I submitted the claims again. They came back decline, again. They said that the provider wasn’t authorized to provide services. I called again. They told me that my therapist wasn’t registered with them as a provider in network. So I had explain that of course she wasn’t registered in network, she’s an out of network provider!

I assume you get the picture. I submitted and appealed, and resubmitted again. I was promised that people would call me back within 24 hours, reps and supervisors alike. And still, no progress.

Finally, at the end of November one rep took the time out to really figure out what was going on. Apparently, my therapist was not in their database as a legal provider. I asked how that was possible, considering that I was billing for this provider for over 4 years. I also asked why it took them eleven months to figure this out. She had no answer. At the end of the day I asked her what exactly my therapist needed to do in order to register.

And so the saga begins anew. My therapist registered, but my claims are still getting declined. I’ve talked myself blue in the face. I’ve threatened to get a lawyer involved. At this point I think it’s time to go from threat to action. I’m looking for a lawyer now that deals with health insurance claims. I’m particularly worried that they are going to start declining them on the basis of the claims being a year old.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>