People are screaming, people are screaming.
We shall call this entry "Kerry vs. The Giant Health Corporation."
The health insurance provided to me by my employer is from an HMO because basically that is the only choice we have in America anymore. Well, and PPOs, but they are usually run by the same company that does the HMO, so what difference does it really make?
The HMO handles all of the claims, but authorization for mental health services comes from a different company (henceforth referred to as CH). As if that wasn't full of pointless bureaucracy as it is, a third company actually acts as a go-between for HMO and CH (aka GB).
I never would have known any of this had I not checked my spam filter only to find a message from the HMO saying that I have an urgent message that I can retrieve on their website. After logging in there and going through several menus before finding the message, it says that my latest mental health claim has been denied due to lack of authorization. Considering that I've always had authorization, this is a bit puzzling. So I send a message back to HMO asking them to clarify. Meanwhile, I go through my other mental health claims and they are all marked as denied for various reasons.
Cue panic attack.
This morning, I log onto HMO's website to find a message from a Claims Rep telling me that she doesn't know why my claim was denied since she doesn't have the authorization to access mental health claims and that I'll have to call GB. That seems rather ridiculous to me, but I call GB. That person also tells me that they don't have access to that information and they tell me to call CH. CH tells me that they can't look at my claims because HMO handles them, but that my authorization expired in October and the doctor needs to call for a new one.
After a break to bash my head on my cubicle wall, I call the doctor and leave a message on his voicemail about the new authorization. He calls me back an hour later to ask me to call his admin about it because he really doesn't deal with the insurance stuff. So I call the admin and she tells me that my health insurance has only paid 2 out of the last 13 claims.
Cue second panic attack.
I tell her that I need a new authorization and she promises to send it in. I promise to call HMO again to see what's up. After playing phone tree yet again, I finally get someone who can help me. This person is a rep from the HMO, by the way. As you recall from a few paragraphs up, the same people who told me they couldn't access my files. Awesome! Anyway, she tells me that all of the claims were paid except for two of them. So she reprocesses the two that weren't. But I'm like, umm, but the doctor hasn't gotten any payment, so how can they be marked as paid?
She explains to me that the doctor was overpaid by HMO during another patient's claim so they withheld my checks to the doctor in order to recoup the overpayment.
djafjkdjfklafjkljdafkldjafkjdklasjfdkjafkjakfjdlajfkljaeiuoiejnovneoauoiefjonvoaoien!!!
WHAT THE FUCK DOES THAT HAVE TO DO WITH ME?!?!?
Since I was at work, instead of screaming that, I asked how everything was going to be fixed so the doctor has a record that my claims were actually paid. Of course, she tells me that the doctor will have to call yet another extension of the giant health bureaucracy (aka FR).
So I call the doctor's admin back and explain that she has to call FR. I try to explain why but really it makes no sense to probably anyone but the HMO, so she takes the number and says she'll straighten it out.
Undoubtedly, I will get a bill from the doctor in the mail at the end of the month that still says that nothing has been paid and will have to start this process all over again.
…
In other news, it's been 65 degrees the past couple of days. So the foot of snow melted and saturated the ground. Of course, then it began to rain. And by rain, I mean torrential downpour with a possibility of a tornado. So our street turned into a river and the park at the end of the block is a giant lake. Plus, they had already turned on the heat at work (you know, since it's supposed to be WINTER), so inside our building, it's even hotter, not to mention humid.
How can it only be Tuesday? Seriously.
The health insurance provided to me by my employer is from an HMO because basically that is the only choice we have in America anymore. Well, and PPOs, but they are usually run by the same company that does the HMO, so what difference does it really make?
The HMO handles all of the claims, but authorization for mental health services comes from a different company (henceforth referred to as CH). As if that wasn't full of pointless bureaucracy as it is, a third company actually acts as a go-between for HMO and CH (aka GB).
I never would have known any of this had I not checked my spam filter only to find a message from the HMO saying that I have an urgent message that I can retrieve on their website. After logging in there and going through several menus before finding the message, it says that my latest mental health claim has been denied due to lack of authorization. Considering that I've always had authorization, this is a bit puzzling. So I send a message back to HMO asking them to clarify. Meanwhile, I go through my other mental health claims and they are all marked as denied for various reasons.
Cue panic attack.
This morning, I log onto HMO's website to find a message from a Claims Rep telling me that she doesn't know why my claim was denied since she doesn't have the authorization to access mental health claims and that I'll have to call GB. That seems rather ridiculous to me, but I call GB. That person also tells me that they don't have access to that information and they tell me to call CH. CH tells me that they can't look at my claims because HMO handles them, but that my authorization expired in October and the doctor needs to call for a new one.
After a break to bash my head on my cubicle wall, I call the doctor and leave a message on his voicemail about the new authorization. He calls me back an hour later to ask me to call his admin about it because he really doesn't deal with the insurance stuff. So I call the admin and she tells me that my health insurance has only paid 2 out of the last 13 claims.
Cue second panic attack.
I tell her that I need a new authorization and she promises to send it in. I promise to call HMO again to see what's up. After playing phone tree yet again, I finally get someone who can help me. This person is a rep from the HMO, by the way. As you recall from a few paragraphs up, the same people who told me they couldn't access my files. Awesome! Anyway, she tells me that all of the claims were paid except for two of them. So she reprocesses the two that weren't. But I'm like, umm, but the doctor hasn't gotten any payment, so how can they be marked as paid?
She explains to me that the doctor was overpaid by HMO during another patient's claim so they withheld my checks to the doctor in order to recoup the overpayment.
djafjkdjfklafjkljdafkldjafkjdklasjfdkjafkjakfjdlajfkljaeiuoiejnovneoauoiefjonvoaoien!!!
WHAT THE FUCK DOES THAT HAVE TO DO WITH ME?!?!?
Since I was at work, instead of screaming that, I asked how everything was going to be fixed so the doctor has a record that my claims were actually paid. Of course, she tells me that the doctor will have to call yet another extension of the giant health bureaucracy (aka FR).
So I call the doctor's admin back and explain that she has to call FR. I try to explain why but really it makes no sense to probably anyone but the HMO, so she takes the number and says she'll straighten it out.
Undoubtedly, I will get a bill from the doctor in the mail at the end of the month that still says that nothing has been paid and will have to start this process all over again.
…
In other news, it's been 65 degrees the past couple of days. So the foot of snow melted and saturated the ground. Of course, then it began to rain. And by rain, I mean torrential downpour with a possibility of a tornado. So our street turned into a river and the park at the end of the block is a giant lake. Plus, they had already turned on the heat at work (you know, since it's supposed to be WINTER), so inside our building, it's even hotter, not to mention humid.
How can it only be Tuesday? Seriously.