Thursday, March 5, 2015

IBM Medicare Supplement Provider Refund Aggravation

We just received a refund check from the hospital for a claim I paid before my spouse's Medicare Supplemental plan agreed to pay it.  In a previous post, I said I'd do a happy dance when I got the check.  Well, it's a short lived happy dance.  Nonetheless, it is a victory.  Seems the complaint letter to the CEO of the hospital did inspire the billing department to get into action and correct the situation.
I thought I was on the path to a full blown resolution of the refund situation and the hospital check would be the final fix.  Unfortunately, a couple of days ago, that changed. We got a bill from my spouse's primary care provider group and there was no refund showing any where on the bill applied to the balance due (that was how they were going to refund our money).  In fact, their bill could not have been more of a mess.  I get the feeling the provider group change accounting systems in the beginning of 2015. 
This new bill showed a new account number and my spouse's name included a middle initial (something they had not done before).  In addition, the bill had a line item for a doctor visit in December 2014 which was not submitted to the 2014 cheapo Medicare Supplemental plan for payment.
I tried calling the group billing department at least five times but could not get an answer.  I decided to skip trying email and sent a letter with copies of an old bill, the new bill and information about the claim refund that is due.  I also told them to submit the December claim to the cheapo insurance. 
I have an hypothesis about all the machinations we've gone through to get our situation resolved.  It seems no matter what the organization: insurance companies, hospitals, doctor groups, governmental complaint agencies, corporations (ergo, Towers Watson) ... all these organizations are operationally incompetent and/or somehow short changing the customer.  My hypothesis is the layoffs, reorganizations, consolidations, outsourcing and the organizational push to be ever more efficient have produced enormous dysfunction. "Do more with less" ends up being "Do less with less and if  the customer gets shabby service so be it".  Where are the Watsons when we need them?

Update on 4/19/15:  Time to do an unreserved happy dance.  The last provider finally sent a refund check.  Wow.  It only took about 6 months to resolve this mess.  Amazing.


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