The HIPAA Critic's Oaths
The golden rule of medical insurance claims: First, do no thing.
Insurance companies claim to dislike HIPAA (Health Insurance Payment Anti-Acceleration) because of all the bureaucratical red taping it demands, but we know better.
A case in point: my Large, Well-Known Medical Insurance Company has a claim pending since April of aught-three involving a routine medical matter for Gladys. Total charge: $86 (American). Our coverage was new and we didn't have the insurance card, so we paid the full amount and filed the claim shortly thereafter.
A number of moons go by...
I send in a photocopy with "SECOND REQUEST" on it.
A number of other moons go by and the claim has celebrated its first birthday, so I call up LWKMIC's Claim Persistance Line and - after some lovely taped ads for them, plus a disclaimer that my call may be recorded to be replayed in the supervisors' lounge as an employee benefit - get an American (in America) on the line...
INSURANCE CLAIM RESISTOR: Thankyouforcalling LargeWellKnownMedicalInsurancethisisJanehowmayIhelpyou.sCHMED: This is Schmedulov Jostikovitch with group IMSOL calling in reference to a claim on my daughter, Gladys, in April of aught-three.
ICR: Mr. Jostikovitch, could you please verify the last four digits of your social?
sCHMED: (fighting back Pavlovian anger because the SSN is again being used for purposes beyond the Soshasecurity System) 1-2-3-4 (and I could probably put the real numbers in there because they aren't very hard to find).
ICR: What is your group number?
sCHMED: I-M-S-O-L.
ICR: Are you the patient?
sCHMED: No, it is my daughter, Gladys, D-O-B MM/DD/YYYY.
ICR: What is the date of the claim?
sCHMED: (Unable to refer the ICR several lines up where all this frustratingly repetitive information exchange was first presented...) Oh-four of Twenty-Aught-Three.
ICR: Just a moment while I retrieve your information.
ICR: Sir, is your daughter with you?
sCHMED: No.
ICR: I'm sorry, but I can't release any information about this claim to anyone but the Provider or the Patient.
sCHMED: I. Am. Her. Father. The responsible party... theguythatpaysthepremiums...
ICR: Yes, but Gladys is over eighteen.
sCHMED: She was seventeen at the time of the doctor visit, and would've been seventeen at the time the claim typically would've been paid...
ICR: Well, she's eighteen now. Is your daughter with you?
sCHMED: (looks around the office, just in case) Nnnnnnnnnnno.
ICR: Well, if she could give me permission, I could release information about the claim.
[A LARGE, 150w LIGHT BULB GOES ON ABOVE sCHMED'S HEAD WITH AN AUDIBLE 'TINK' SOUND]
sCHMED: Could I place you on hold while I get her?
ICR: (schmed puts her on hold before she can answer)
[schmed dials Gladys' cell...]
sCHMED: Gladys! Hey, y'got a minute to talk to the Insurance Lady with yer Old Man?
GLADYS: Um, sure.
[schmed hits "CONF" button]
sCHMED: Ma'am?
ICR: Yes?
sCHMED: I have Gladys on the phone with us and she'd like to know the status of the claim.
ICR: OK. Gladys, can you verify your date of birth?
GLADYS: MM/DD/YYYY.
ICR: OK, thank you. We requested a breakdown of the charges from the doctor and haven't received a response.
sCHMED: Um, when did this take place?
ICR: May bempty-blempth of 2003.
sCHMED: And you followed-up - when?
ICR: I can submit another request if you would like.
sCHMED: (in an eerily pleasant voice) Gladys and I would like that very much. She would also like some notification by mail of the status from time to time, wouldn't you Gladys?
Not that it matters, but the claim is still unresolved, so the Large, Well-Known Medical Insurance Company hasn't paid the Doctor $17.38, so the Doctor hasn't written off the $68.62 balance or remitted the original $86 to
I won't even try to get the Doctor's office to credit it against Guido's outstanding balance - I don't think I could refrain from speaking those oaths out loud.
I hope you're charging interest and have turned the this matter over to a collection agency. Won't thisisJanehowmayIhelpyou be surprised when Frankie Kneebreaker and Knuckles Malloy show up to collect the cash.
Posted by: CC | Wednesday, October 13, 2004 at 10:36 AM
LOL - "resistor". Yep, that definitely describes them. I'm impressed though that you got to speak to a supposed real person. Mine, just have to field your way through all the menu "options".
CC has a great idea! Why is it THEY can turn us over to a collection agency and not the reverse?
Posted by: GrumpyBunny | Wednesday, October 13, 2004 at 11:10 AM
I muscled my way into a loaner car at BigAuto yesterday. You want I should kick some ass for you? I have a way with people.
Posted by: Kay | Wednesday, October 13, 2004 at 02:04 PM
Heh, you think you got problems? Remember Thing One's chest surj-ree?
Yes, well after the shawance company gave the surgeon's office AND the hospital the go-ahead we got a letter in the mail when we got home four days AFTER the surgey saying coverage was denied.
Shall we start a pool to see how long this one takes to get resolved?
Posted by: Rockynoggin | Wednesday, October 13, 2004 at 06:19 PM