The gods do not want me to have an easy time with Extend Heath for either enrollment or for HRA claims. I just successfully submitted my first claim request to Extend Health after 3 weeks of trying. Don't read that sentence as I will be paid for the claim. It just means they finally got the claim after several attempts, multiple phone calls and several emails.
In the beginning of January I faxed a claim to Extend Health. I heard nothing for 3 weeks. I called them last week and they said they never got my claim. They blamed my fax machine even though on the same day I sent the fax to EH, I successfully sent a fax to Acclaris. On Monday I sent another fax. I called EH on Tuesday to ask if it had arrived and was told Monday was a holiday so they wouldn't have gotten it. After being on hold for 20 minutes they told me they had no fax from me but it would take a day or so to go through faxes they received. On Wednesday I sent another fax and an email to the IBM support address IBMSupport@Extendhealth.com asking for help. I was then told by email that it takes up to 5 days to just enter a faxed claim into the system for processing. No one on in the call center told me that - they just led me to believe my faxing capability was not working. In the meantime, I also found on the claims processing site there is a notifications setting to ask to have an email sent to you when a claim is received. It is not on the main website for Extend Health where your profile is stored but on the website you are redirected to for the actual claims process. I also found an email address - enotify@payflex.com. I sent an email to that address and it bounced back that the mailbox was full.
Today, I was finally notified my claim has been received because I had set the notification setting to do so. Yay.
Friends told me to just mail in claims. That means spending printer ink to make copies and stamps to mail it. I didn't want to do it online either because I want rock solid evidence of claims I have submitted.
Here is my observation - people who pay the whole year's premium for their insurance up front in January, and send in a paper claim to Extend Health to get their money back are clever devils. They only have to front the money to pay the entire year of premiums for a few weeks and then they get a check. In one case, the IBMer and the spouse insurance premium costs for medigaps and part D plans for the year was the entire subsidy and the HRA account was drained in January. That person has the money and doesn't have to deal with Extend Health again until next year. How smart!
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This article really struck home with me, and the inconsistent way Extend Health handles claims. My personal experiences have been at both ends of satisfaction. I have been filing the claims directly online. Filing online is easy, you just select file a claim and follow the prompts. When submitting the documents online you must upload a PDF file for Extend Health to accept it. Only thing I have found out is at times if you have multiple documents to submit, when after the first document has been selected trying to select additional documents seem to be an issue (seems like system hangs). Not sure why but what I have been doing is to scan all the supporting documents into 1 file then I have been able to complete the submission process. I will be adding another comment on my good and bad experiences but I want to wait until I contact Extend Health again.
ReplyDeleteAfter I wrote this post, EH processed my faxed claim. They missed one of the entry items and rejected two items because they wanted more policy proof re: medigap. A letter from the medigap wasn't enough. Sigh. It was easier for me to double check exactly what I submitted and what they missed or rejected with my faxed claim so I am going to stay with the fax process for a few cycles.
DeleteOne thing I have resorted to is to record all my conversations with Extend Health, only because of the inconsistent responses I had received.
ReplyDeleteExtend Health also requires a cancelled check to be submitted with a invoice copy. for recurring expenses at least for the Medicare part B the SSA letter was acceptable.
I also prefer to pay premiums for the entire year if possible, so I don’t have to mess with the monthly bills.
First, I enrolled in a prescription plan that has automatic reimbursements. I received my coupon book and paid for the year. January 3rd I filed an online claim for the premium and within a couple of days extend health had deposited the money in my checking account. Great!
Not being sure if Extend Health was honest with the reimbursement of annual payments and before my prescription reimbursement had been processed I filed the next 3 claims for premiums. These were for My wife and my medigap plans and my wife’s prescription plan. They also went smooth. I submitted them online and within a few days the reimbursement was in our checking account.
Not sure what is going on at Extend health but since then everything seems to be getting messed up. On January 10th I submitted forms for recurring payments of the $104.90 monthly Medicare part-B premiums for my wife and myself (these must be faxed or mailed in) with the supporting documents. Within few days we had the January reimbursements in our checking account. On January 21st I logged onto my extend Health account and saw that from February through December that 1 of our Part-B claims were showing as denied because it was a duplicate entry. I only submitted 2 requests (1 for my wife and 1 for me and we both purchased medigap plans through Extend Health) I called Extend Health and after explaining the situation the rep said everything I sent in was ok and it must be a glitch and a supervisor would get back to me within 24 hours. Anyway on January 24th I called them back. After going through it again this rep verified that all my information was correct and he was forwarding the information to the claims section and it should be resolved by mid-week (January 29th). For some reason you can never speak to anyone that does the claims processing they are never available (Very frustrating). Anyway that afternoon I get the duplicate rejection letter in the mail.
While this other stuff is going on I get our next bills for the medigap plans and documented on the stubs I was paying for the rest of the year. When the cancelled checks were available I went online and submitted them. This is when I found their system appears to have an issue with submitting multiple PDF files. Anyway I tried submitting them twice and after inserting the first document things just seem to hang so I scanned the supporting documents into 1 file and was able to get to a successful submission screen. January 30th I logged into my account and it showed the medigap reimbursements were sent and today January 31st they are in my checking account. For all the frustration of dealing with Extend Health, the turnaround for doing the claims online is pretty good. Submitted on January 24th in my checking account January 31st. I’ll just be glad when I don’t have to deal with them until next year. They have also corrected the denied entries as of today. I would much prefer dealing with IBM when I didn’t get a run around and received answers on the first call.
Extend Health subcontracts payment processing to PayFlex (www.payflex.com) and that PayFlex is not supposed to be the customer facing entity. I think you should send an email of your experiences to IBMsupport@extendhealth.com because I have found EH is then very responsive and it seems they then "fix" the problems with PayFlex. I think those emails are monitored by IBM because once I sent an email to that address the issues I had were quickly cleared. I will also write this in a post.
DeleteIn the beginning I was very satisfied with the claim processing from my HRA.I have my Medicare part D drug coverage through EH with "auto reimbursement",and the January reimbursement showed up in my checking acct in early Feb.I paid my medigap type F HD premium for the whole year(they give me a discount),filed a paper claim,and the reimbursement was in my checking acct in a timely matter. I signed up for the Cigna Dental conversion plan,and they require the payment for the first quarter with the application,and send you coupons for each following quarter's payment.I filed a paper claim using the recurring premium form which only allows a monthly premium amount,so put a one month amount on the form.I included a copy of my cancelled check for three months payment and a copy of the coupons,each showing the three month amount due.My claims history showed they made an electronic payment on 2/3/2014 for the January premium and another electronic payment on 2/3/2014 for the February premium,but the word "unremitted" was next to the one for February,even though it was deducted from my HRA balance.The first one showed up in my checking acct on 2/3/2014,but the second one didn't.On 2/4/2014,I called EH to find out what was going on and what the "unremitted" indicated.After talking to the first EH rep,I was put on hold while he got hold of a person who did claims.A while later,they both came on the line,and I explained the problem again.The claims person(these are not people at the claims site in Omaha) could not explain the "unremitted" and,after some discussion,told me to wait 3-5 days,and if it didn't show up in my checking acct,to call back.On 2/5/2105 it was still not in my checking acct,but the word "unremitted" had been removed from the claims history. I took your advice and sent an email to IBMsupport@extendhealth.com, documenting my earlier conversation with EH. The next day 2/6/2014 it showed up in my checking acct. As of today 2/7/2014,I have not heard anything from EH,so don't know if the email I sent to them got it fixed,or something else did.My last outstanding claim is for a dental copay.I sent them the invoice from the dentist showing the dental procedure # ,my payment(which was what the dentist said my copay was for that procedure)and the balance remaining which was being sent to the insurance company. EH denied my claim,saying part of the amount I paid may be covered by insurance,and wanted me to send them the EOB. Cigna has never sent me an EOB,for all the years I have been with them.The dentist looks in their computer to see my copay,asks for my payment on the spot,and bills Cigna for the balance.I sent the claims dept a note saying Cigna doesn't send EOB,and that I was including a copy of the patient charge schedule from my Cigna book,showing the copay(the amount my claim was for)for the dental procedure # I had done.I hope this will be enough for them.I just wish we could talk directly to the people who handle our claims.From my call to EH,it appears they just look at the same thing we can already see by looking online at our claims,and they told me they don't even talk directly to the people doing the claims.It seems VERY inefficient,but the whole EH thing does.Just give us the HRA money each year,and leave us alone to use it as we want.
ReplyDeleteI wish IBM could just give us the money but IBM needs to prove to the IRS that the money we get is truly being spent on medical, prescription drug and dental insurance and expenses to keep it tax free. The problem, as I see it, is that Extend Health and PayFlex have a miserable process for collecting the documentation to prove to the IRS how we are spending the money. In the past, IBM spent the money for us so it was easy for IBM to prove how the money was spent. I think you have to keep Extend Health under inspection by telling IBMsupport what you are experiencing.
DeleteI hate to burst your bubble in regard to emails sent to ibmsupport@extendhealth.com, but apparently the email I sent to them on 2/5/2014 in regard to my claim showing paid,but not being in my checking acct,had nothing to do with the money showing up in my checking acct the next day 2/6/2014. On 2/24/2014, 19 days after I sent them the email,I received a call from EH,wanting to know what was my concern in regard to my claim.I wasn't home,so they left a msg.When I called the next day, I told them the money showed up the next day after I sent them the email,so my problem was resolved. I asked if 19 days to respond to an email was "normal". First I was told an appeal could take some time. After I said I didn't file an appeal,just sent an email to see why the claim said paid,and no money was in my account,they said the 19 day response time could have been due to the bad weather in Omaha(where the claims are processed).I wonder who the emails sent to ibmsupport@extendhealth.com go to. When I mentioned the name of the person who had left me the phone msg,the EH rep asked me how that named was spelled,to which I replied "it was a PHONE msg". What I have been able to figure out is that at first the history shows an electronic payment with "unremitted" next to it. The next day the "unremitted" is gone,and a day later the money shows up in my checking acct(set up for direct deposit). This has been the pattern for my last two claims. Also in regard to my earlier comment,EH did accept the copy of the CIGNA patient charge schedule I sent them showing my copay, in lieu of an EOB,and paid my dental claim.As of today,all of my claims have been paid,and my recurring monthly premiums reimbursements are current.
ReplyDeleteI had hoped that IBM was trying to be sure Towers Watson was doing a good job but maybe they don't care. I really don't know what else to advise.
DeleteFinely depleted my HRA account glad that is over for this year. FYI I've been getting the run around from Blue Cross about the Medicare crossover. They are not responsive (5 of them) to emails at customer service and when I had been able to talk to a real person they told me i had to contact COB and COB doesn't return calls. Anyway I called the state insurance commissioners office to complain and the next morning I received a call from Blue cross management telling me they were going to handle getting the crossover taken care of. Next time I will call Insurance commissioner's office sooner.
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