Tuesday, April 27, 2010

Oh Insurance...

Oh insurance company, you were rude to the wrong person.  I have fought to long and to hard for you to go and try to screw me now!

See Today I went to the mailbox and got the mail.  In the mail was an EOB.  Everyone knows what that is right?!  For those that don't know, an EOB is an  Explaination of Benefits.  The insurance company sends one to you everytime they have to pay a claim.  Now most people probably don't even look at it.  But when you have a child with special needs that sees multiple therapists, doctors, has lots of assessments and tests, you tend to look at everything.  So I opened this EOB and nearly had a heart attack.  I saw at the bottom "Patient responsibility: 702.48"  Oh My God!!!  I immediately started scanning the EOB.  The explaination was for speech/occupational therapy that Avery received while we were still living in Pennsylvania.  It was therapy done at Hershey Medical Center.  It showed what they billed the insurance and then that the insurance only paid a little over 100.00 on each session for a total of 4-5 sessions.  Next to each session was the code "30".  At the bottom of the EOB it shows the codes and what the codes stand for. Next to the "30" was the words "Not a PPO provider"

What?!  I KNOW the therapists called the insurance and I personally went back and forth with the insurance multiple times fighting them to cover his therapy.  There was no other provider in our area that could treat for the things he needed to be treated for.  They authorized this therapy!  They said they would cover it at "typical PPO provider rates."  That means they would cover 90% for the therapy.

I immediately called my husband who told me "Oh no, you better call the insurance right now."
"Should I wait and see if we get a bill?" I asked him.
"No! You call them and take care of the problem before we get a bill!" He replied.

I took a deep breath and called the insurance.  You see the problem with my husband's insurance is that he works for a Union.  Because he works for a union they have a "health fund" which takes care of paying all the insurance claims.  We have Cigna PPO insurance, but they are just the "go between" really.  The ones that I have to deal with every time I have a question about benefits, or coverage, or I have to fight them to cover something, I have to deal with The Sheet Metal Workers Local 100 Fund Office.

Calling them is torture.  Why you ask?  Because they are the rudest people ever.  Every single time I call they talk to me like I'm a complete moron who is not worth their time.  See this was our exact conversation this afternoon:

Them: "Sheet Metal Workers Local 100 health fund."
Me: "Yes, Hi! I have a question about an EOB I received today.  I don't know if I should talk to you, or maybe someone else?"
Them: "Oooookay (real attitudish) are you a doctor, insured, what?"
Me: "My husband is the insured, I'm calling about an EOB for my son, who is a dependant."
Them: "And do you maybe have a claim number or anything?"
Me: "yes, I do the claim number is *******."
Them: "Ok let me look at my copy" *pause* "And what is the problem" (again with the attitude!)
Me: "I don't understand why my portion is so much."
Them: "Well if you look right there it tells you that it isn't a PPO Provider"
Me: "I understand that, but if you would look in our notes you would see that my son has special needs, and there's a note in his chart that says these appts are covered at the 90% rate.  It was pre-approved through you guys before he ever went there."  (now I was getting mad because she was being so rude to me!)
Her: "well then maybe they never looked at your notes, hold on a second."
Her: "Ok I see the notes in your file, Obviously they never looked at your notes before paying the claim. I will resubmit this claim to be redone."
Me: "I appreciate that. Thank you."
Her: "Uh huh, bye"

Seriously, is there any need to be so rude to me?  It isn't like you aren't being paid to deal with this stuff.  It is your job to answer the phones NICELY I might add and deal with this stuff.  So why do you have to be so rude?

They really should hire people who are more people friendly.

This isn't just a one time thing either.  It's every single time I call.  No wonder I get the comments from the doctors offices "gosh, they're just a peach to deal with" (sarcasm if you can't tell), When the doctors office calls to verify benefits or anything.  So they aren't just rude to me!

So Cigna PPO or Sheet Metal Workers Local 100 if you see this blog post, maybe you could hire people who actually like their job and like talking to people.  Cause you aren't making a very positive impression on people.

*yes linky love to them so it makes it easier for them to see this blog post!*

1 comment:

Anonymous said...

This is Jessica from the BBC boards...I had to chime in because I work for a health insurance company...no...not Cigna. It frustrates me to see stories like this because we are so focused on customer perception and helping the customer. Not all health insurance customer service departments are like this. I am sorry you have one like this. I am glad they took care of your claims.