Filed by NinjaDoll on March 9th, 2007
Voice – Hi, this is American Usual Insurance, how may I help you?
Me – Good morning! I’m a subscriber with your company and I’ve been receiving some conflicting correspondence from you that I’d like to get cleared up.
Voice – Conflicting? What do you mean?
Me – There is a claim filed for some lab work I had a couple of months ago. I received three notices from you that stated that I did not have to do anything further regarding the notices, but that you were requesting information from the lab to complete the processing of my claim. Yesterday, I received another letter from you stating that you had not received a response from the lab and that I should follow up with them.
Voice – And?
Me – I don’t know what you’re asking me to follow up. I don’t have copies of the correspondence between you and the lab.
Voice – Let me check your records, one moment, please. *long pause* It says here that your doctor needs to provide information regarding the lab work he ordered on that date.
Me – Then why are you asking the lab?
Voice – Excuse me?
Me – Was the letter you sent to the lab intended for my doctor?
Voice – Yes, your doctor needs to provide information regarding the lab work he ordered on that date.
Me – Why didn’t you send the letter to my doctor?
Voice – We sent it to the lab.
Me – Apparently you’ve sent it to everyone but my doctor. Are you wondering why you haven’t received a response yet?
Voice – If he doesn’t respond by the end of this month, the claim will be considered void and you will be responsible for paying the full amount.
Me – How much is the bill?
Voice – I don’t know, ma’am, I only see the filing histories, not the claim amounts.
Me – Alright. Let me give you the name and address of my doctor so you can send the letter to him.
Voice – We can’t do that.
Me – Why not?
Voice – The correspondence has already gone to the lab and if we change the recipient it will only further delay your claim processing.
Me – Can’t you just photocopy the letter you sent to the lab and send that to him? You don’t care where the response comes from as long as you get the response, yes?
Voice – Well, that’s for you to do. You can send him a copy of the letter you received from us.
Me – I don’t have a letter with questions on it. I have a letter demanding answers to questions on it, but it doesn’t contain any questions.
Voice – I’m sure the lab has the answers we need, why don’t you call them?
Me – They wrote me a letter saying it is my responsibility to get the answers from my doctor.
Voice – Then you should call your doctor.
Me – What do I ask him?
Voice – Ask him to respond to the questions regarding this claim so that we can begin processing it.
Me – What are the questions?
Voice – The questions we’ve been talking about this entire time.
Me - *pause* Let me recap where I am in trying to understand this confusion. You have sent questions for my doctor to everyone but my doctor, and because my doctor hasn’t responded, you insist that everyone except you hunt him down and demand that he provide answers to questions he hasn’t even been asked?
Voice - *no response*
Me – I guess I got it right, huh?
Voice – You’re making this more complicated than it really is.
Me – I beg to differ.
Voice – Well, we’re not going to get your claim resolved if we don’t hear back from your doctor.
Me – Do you have a pen?
Voice – Excuse me?
Me – Do you have a pen?
Voice – Yes
Me – Good. Write this down. It’s the name and address of my doctor so you can send him your questions and get your answers.
Voice – I told you, I can’t change the information in the computer.
Me – You don’t have to. You’re going to photocopy the letter you sent to the lab and mail it to my doctor.
Voice – You said you got a as well, you should have forwarded it on to him yourself.
Me – My notices (because you sent me three) only said that you needed further information from my doctor, and that I needed to do nothing more regarding this claim. There were no questions.
Voice – *irritated* Of course there were questions, what’s the point in sending you questions for your doctor if there are no questions on it?
Me - *after a short pause* Are you ready to take down his name and address now?
Voice - *snapping* I have his name and address.
Me – Then send him the questions so we can both put this behind us and talk about…oh, I don’t know. What the weather’s like in Kurzistan this time of year.
Voice – You don’t have to get sassy with me, ma’am, I’m doing the best I can.
Me – I apologize. My fundamentally sane side is regressive for some reason.
Voice – What I don’t understand is why your lab asked you to go to your doctor.
Me – That’s a different conversation that needs to take place. So…are you going to send the questions to my doctor?
Voice – I suppose I could do that.
Me – Great. Now, if you don’t get a response back in a week (and I’ll call him after this to make sure he’s watching for your letter), would you please let me know?
Voice – Ma’am we process literally thousands of claims each day, which is why our correspondence is all automated.
Me – As of this moment, my claim is not being processed so I’m completely out of the automation loop, in a manner of speaking. Could you not just stick a post-it note on your calendar to check on my claim and call me?
Voice – But I don’t handle claims, I’m only the receptionist.
Me - *pause* Then how do you have access to my claims?
Voice – Because it’s in the system, and I have access to the system. But I don’t have all the information, just some of it.
Me – You haven’t seen the questions, either, have you?
Voice – No ma’am, I have not.
Me – Do you have enough access to my files to find the letter and have it sent to him?
Voice – No, but I’ll speak with the claims supervisor, he’ll be able to do it.
Me – And you’re reasonably sure he’ll send it?
Voice – I’m writing your doctor’s information down for him right now.
Me – *exhaling* Alright. I’ll call you back in a week, how’s that? Then you can check to see if my claim is on track?
Voice – That would be fine.
Me – Terrific. Thanks for your time!
*****
Voice – This is Laboratories USA.
Me – Hello! I’m calling regarding a claim that you’ve filed with my health insurance company that appears to be problematic? Can you help me?
Voice – What’s the problem?
Me – The insurance company appears to be waiting for answers from my doctor, however they sent the questions to you instead, and they’ve not been forwarded to my doctor.
Voice – Due to privacy concerns, any correspondence we receive in error can only be sent back to the original sender.
Me – Really? You sent me a letter saying you received a letter from my insurance company, but that you wanted me to follow up with it because your claim has not yet been processed. But there were no questions in it, just some talk about late fees and such.
Voice – How long ago did you come in for the lab work?
Me – A couple of months ago.
Voice – Oh, then, yes, you would incur late fees if the bill is not paid in full in 30 days.
Me – But my insurance agency is trying to pay their portion, and I would like to pay my portion once I know what their portion is.
Voice – You are ultimately responsible for your total bill, so it doesn’t matter whether you pay, or your insurance company pays, if you’re two months overdue, you’re two months overdue.
Me – *trying to be Zen* Let’s back up a moment. Did you send a copy of the insurance company letter to my doctor?
Voice – No, we sent it to you.
Me – The letter you sent me doesn’t have any questions for my doctor, it merely says that you received a letter stating that the insurance company had questions for my doctor. I would like you to see about sending the original letter to my doctor.
Voice – Shouldn’t the insurance company be doing that?
Me – Someone should be doing that, but for some reason everyone thinks it should be me!
Voice – We don’t normally forward correspondence like that.
Me – Why not?
Voice – We have privacy concerns that we have to contend with.
Me – *at this point, fuming* Privacy laws? This is the gentleman who sent me to your company so you could stick needles into me and have me pee in a little cup. You then tested all my blood – five vials - , dipped a stick into my little pee-pee jar, figured out what was wrong with me, and sent the results back to my doctor. You mean to say that, after all that, you can’t forward him a copy of a letter that’s of financial importance to the both of you?
Voice – You should forward him the letter that we sent you.
Me - *nothing*
Voice – Is there anything else I can help you with today?
Me – No. Not today. Not any day, apparently. *click*
*****
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