I know, I know --- how geriatric am I --- I use a fax machine to submit my claims. How antique. I also do not do recurring/automatic payments. I am faxing claim submissions for several reasons.
I can quickly and easily talk through claims processing errors with OneX while making notes on the submission claim form so that there is a clear record of my interactions. I skip the snail mail cost of stamps and printer ink to make copies of claims and documentation by faxing. Mostly, I believe it will be a lot easier for my family to know exactly what claims I have submitted and read about all my conversations with OneX by just looking at my hardcopy claims folder if I am unable to do it. My spouse is totally cantankerous about this IBM transition (read that as ornery), resents the HRA funding process and would abandon the reimbursement rather than dig around my computer to figure out the process. I've warned the kids about it but when I try to show the process to them their eyes glaze over. My feeling is maybe my hardcopy folder will help them quickly understand the process and history. However, I have reconsidered my position on recurring payments and decided I should enroll in those payments just because of that last reason. It would mean that at least the insurance premiums would be automatically reimbursed if I am unable to submit claims and no one else takes the time to file claims. Anyway, OneX also made a lot of mistakes last year. Unfortunately, the mistakes continue.
In January, a processor rejected one of my claims saying there was inadequate documentation. I called OneX and the call center rep went through the fax image of the claim. She said the processor clearly made a mistake and she'd send it in for review. I never heard about that claim again. Two days ago, two of my claims were rejected for the same reason. The call center rep I spoke to yesterday said the fax pages must have not transmitted. When I asked if he went through the fax image to see if they had transmitted, he admitted he did not. But, it didn't matter, he said, since the only way to get all three claims reconsidered was to resend them to OneX. Sigh.
It's not a big deal to resubmit the claims, just annoying. They are premium payments so I am going to do the recurring/automatic payment process for all our premium payments to try to curb the processing errors as well as deal with my recalcitrant spouse.
Update:
Well, I, once again, am an idiot. No matter how many times the call center representatives give me incorrect information I continue to believe them. I called OneX to activate Automatic Reimbursement for the policies we bought through OneX thinking she could just "do it" and I wouldn't have to troll around the website. The call center rep told me I had to submit a recurring reimbursement form. I asked if I could do it online but she told me I needed to send in the form. She said she could just mail me the form or I could get the form online but I had to send in the form. She never asked nor did I say we bought the policies through OneX. I assumed (there I go again being an optimist) she could see it in our account. I had some forms they sent out last year so I didn't need to go online. After I faxed the form I decided to read the back of it and the form doesn't apply for policies we bought through OneX. Then, I decided I should just go online and see how to activate it. It is embarrassingly simple. Duh.
Thursday, February 19, 2015
Saturday, February 14, 2015
IBM Medicare Supplement Provider Refund Problems
My happy dance over getting the 2014 cheapo supplement insurance plan to properly pay claims didn't last long. Since the middle of December I have been trying to get the providers (doctors and hospitals) that have been overpaid to refund our money.
The Medicare supplemental (aka medigap) insurer sent us a letter stating they only provided claim payments to providers and not to beneficiaries. We had paid all the claims to these providers, who were very prompt about requesting payment, by the end of September. So, when they received payment from the insurance company they were obviously overpaid. I waited a couple of weeks after being notified the insurance company sent them payments before calling providers to see if they got the money and issued refund checks. I am such an optimist. By early January, I received no refunds so I started calling providers that had been overpaid. It was an easy call for doctors who were part of a group practice. The accounting office readily agreed they were overpaid and said they would refund the money. I am mildly irritated that I needed to call at all, but at least they acknowledged the overpayment.
Dealing with the hospital and the hospital doctors was not as easy by a long stretch. I struggled through calls to different accounting departments - which I had to do based on what service was provided. I was told there were multiple accounts and needed to talk through each procedure's payment for the customer representative to tell me whether or not it was overpaid. In one case, the customer representative said they had sent a payment back to the insurance company because it had been overpaid. In another case the customer rep said a claim had never been submitted to the insurance company but that she would do it. Unbelievable, right?
One customer service rep finally did agree a refund was due and said it would be sent. It was less than what I believed it should be but at this stage any refund is a good refund. Anyway, nothing was repaid to us. In mid January I wrote to the different accounting departments in the hospital (no joke) and provided evidence of overpayment to try to get a refund. Still, we received nothing. This week (mid February) I wrote to the hospital CEO to complain about the situation.
I also went on the hunt for a governmental agency that might help. It turns out the Department of Health only takes complaints about providers who are medically negligent. They clearly state, don't complain to us if you have a billing problem. Medicare won't take the complaint. CMS (the agency handling Medicare operations) clearly states they only handle provider fraud complaints. Fraud is when a doctor bills Medicare for a procedure that was never administered. This isn't fraud. The only agency I found where I can complain is the state Attorney General Consumer Protection Bureau. I am hoping I don't have to do it as it will likely take months, if not years, for the Consumer Protection Bureau to even read my submission much less act on it. All governmental protection agencies have had significant personnel reductions. It's no wonder organizations are casual about their consumer interactions. The complaint process is also onerous as I have to supply all the supporting documentation as well as file the complaint. I sure hope the CEO letter provides some magic.
So, I once again urge you all to be diligent about analyzing your insurance statements, making sure doctors have submitted claims properly and making sure you track your deductibles before making provider payments.
Update: The CEO complaint letter seems to have been the catalyst to finally get the hospital to refund money. I just got off the phone with the billing supervisor who agreed that we are due a refund but not without some taffy pulling. At first she insisted there was no refund due. I had all the information about the claims, dates and payments and started listing them off. She then looked more closely at all the claims and agreed the hospital had been overpaid. She said, "I was just looking at the payments for May". It's beyond me why she was not looking at ALL the payments! Although I feel it might finally be resolved, I will refrain from doing a happy dance until I get the check.
The Medicare supplemental (aka medigap) insurer sent us a letter stating they only provided claim payments to providers and not to beneficiaries. We had paid all the claims to these providers, who were very prompt about requesting payment, by the end of September. So, when they received payment from the insurance company they were obviously overpaid. I waited a couple of weeks after being notified the insurance company sent them payments before calling providers to see if they got the money and issued refund checks. I am such an optimist. By early January, I received no refunds so I started calling providers that had been overpaid. It was an easy call for doctors who were part of a group practice. The accounting office readily agreed they were overpaid and said they would refund the money. I am mildly irritated that I needed to call at all, but at least they acknowledged the overpayment.
Dealing with the hospital and the hospital doctors was not as easy by a long stretch. I struggled through calls to different accounting departments - which I had to do based on what service was provided. I was told there were multiple accounts and needed to talk through each procedure's payment for the customer representative to tell me whether or not it was overpaid. In one case, the customer representative said they had sent a payment back to the insurance company because it had been overpaid. In another case the customer rep said a claim had never been submitted to the insurance company but that she would do it. Unbelievable, right?
One customer service rep finally did agree a refund was due and said it would be sent. It was less than what I believed it should be but at this stage any refund is a good refund. Anyway, nothing was repaid to us. In mid January I wrote to the different accounting departments in the hospital (no joke) and provided evidence of overpayment to try to get a refund. Still, we received nothing. This week (mid February) I wrote to the hospital CEO to complain about the situation.
I also went on the hunt for a governmental agency that might help. It turns out the Department of Health only takes complaints about providers who are medically negligent. They clearly state, don't complain to us if you have a billing problem. Medicare won't take the complaint. CMS (the agency handling Medicare operations) clearly states they only handle provider fraud complaints. Fraud is when a doctor bills Medicare for a procedure that was never administered. This isn't fraud. The only agency I found where I can complain is the state Attorney General Consumer Protection Bureau. I am hoping I don't have to do it as it will likely take months, if not years, for the Consumer Protection Bureau to even read my submission much less act on it. All governmental protection agencies have had significant personnel reductions. It's no wonder organizations are casual about their consumer interactions. The complaint process is also onerous as I have to supply all the supporting documentation as well as file the complaint. I sure hope the CEO letter provides some magic.
So, I once again urge you all to be diligent about analyzing your insurance statements, making sure doctors have submitted claims properly and making sure you track your deductibles before making provider payments.
Update: The CEO complaint letter seems to have been the catalyst to finally get the hospital to refund money. I just got off the phone with the billing supervisor who agreed that we are due a refund but not without some taffy pulling. At first she insisted there was no refund due. I had all the information about the claims, dates and payments and started listing them off. She then looked more closely at all the claims and agreed the hospital had been overpaid. She said, "I was just looking at the payments for May". It's beyond me why she was not looking at ALL the payments! Although I feel it might finally be resolved, I will refrain from doing a happy dance until I get the check.
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