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#1
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[OT] Why do insurance companies have to make things so complicated?
I'm seeing a therapist. Therapy is supposedly covered under our
insurance, at a very good rate, but my therapist doesn't file the paperwork herself, so I have to pay her at the time of service and then get reimbursed by the insurance company. No problem. Well, I have a receipt for a bunch of visits, and now I want to file with the insurance company for them. It's DH's company, so he printed off some paperwork, and I'm now trying to sort out how I'm supposed to fill this stupid thing out. The guidelines for filing a claim: 1) A new claim is being submitted for a different family member (okay, that makes sense) 2) A new claim is being submitted for a completely different illness or injury (should I consider my mental health an illness or an injury? I don't think I'm either mentally injured OR ill! And does each separate session count as a separate little pathology being addressed, or is it all a part of the same thing?) 3) Any health claim form is acceptable to insurance co. (huh? What on earth does that mean?) Later, it says, "If you receive add'l bills in connection with this claim after you have mailed this form, PLEASE DO NOT COMPLETE ANOTHER FORM" (emphasis theirs). Okay, then, uh ... how exactly do I submit additional bills? Gee, they're curiously silent on that front. Now completely bewildered by the instructions, I move on to the claims form itself. Here it wants to know all sorts of non-pertinent details, like are any other family members employed. What? Huh? WTF does this have to do with anything? Oh, right, they want to check and see if your company will pay, instead. Except, no, they already have a checkbox for "occupational illness or injury?", so WTF? They actually want the address of my employer, too. I really think it's ridiculous that they make me fill out all of this information. What's particularly ridiculous is that we already had to fill all this horse**** out when enrolling in the insurance in the first place. Oh, and at the bottom, there's no option to get checks mailed directly to me. Only to the provider. Even though I've already paid, and paying up front is pretty common in these situations. And they call the provider a physician, which puts me in uncertain territory, since the provider in this case isn't an MD at all. I'll end up calling them once again to try to straighten all this mess out. Grr. I think I've spent more time on the phone with this farking insurance company than I have with my own mother. Once they finally decide to pay up, their coverage is great, but I honestly suspect that their entire business is based on the premise that if they make the process of collecting benefits difficult enough, their clients will give up. I actually wonder if this is the wrong form entirely. There isn't even a space on the claims form to enter the total amount that was billed. I wonder if this is specifically intended for injury scenarios. But if that's the case, shouldn't there be a type of form to handle more typical health care scenarios? -- monique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca |
#2
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[OT] Why do insurance companies have to make things so complicated?
Monique,
I would just fill it out as best you can and send it in with a photocopy of the bill. There's probably a lot of stuff on their standard form that doesn't pertain to your situation, but they try to make the forms as general as possible. So you can ignore whatever doesn't seem relevant. Don't worry about all that stuff about "is this a new injury" or whatever. Mostly they just want to see the bill, with a diagnosis code, number of hours, and the amount billed, plus your signature. Oh, and if you leave the part about "send the check to the provider" blank, the check will come to you by default. I've had doctors who don't do any of the paperwork either, and that's how it's done. The insurance co assumes they're sending the money to you, unless your health care provider agrees to defer payment until the insurance company coughs it up, in which case you would have the check sent to the provider. I think that's the minority of cases, though. Most providers who aren't part of a PPO or HMO, etc, don't want to wait for reimbursement from the insurance companies - that's part of the reason they don't join plans to begin with! Joyce Monique Y. Mudama wrote: I'm seeing a therapist. Therapy is supposedly covered under our insurance, at a very good rate, but my therapist doesn't file the paperwork herself, so I have to pay her at the time of service and then get reimbursed by the insurance company. No problem. Well, I have a receipt for a bunch of visits, and now I want to file with the insurance company for them. It's DH's company, so he printed off some paperwork, and I'm now trying to sort out how I'm supposed to fill this stupid thing out. The guidelines for filing a claim: 1) A new claim is being submitted for a different family member (okay, that makes sense) 2) A new claim is being submitted for a completely different illness or injury (should I consider my mental health an illness or an injury? I don't think I'm either mentally injured OR ill! And does each separate session count as a separate little pathology being addressed, or is it all a part of the same thing?) 3) Any health claim form is acceptable to insurance co. (huh? What on earth does that mean?) Later, it says, "If you receive add'l bills in connection with this claim after you have mailed this form, PLEASE DO NOT COMPLETE ANOTHER FORM" (emphasis theirs). Okay, then, uh ... how exactly do I submit additional bills? Gee, they're curiously silent on that front. Now completely bewildered by the instructions, I move on to the claims form itself. Here it wants to know all sorts of non-pertinent details, like are any other family members employed. What? Huh? WTF does this have to do with anything? Oh, right, they want to check and see if your company will pay, instead. Except, no, they already have a checkbox for "occupational illness or injury?", so WTF? They actually want the address of my employer, too. I really think it's ridiculous that they make me fill out all of this information. What's particularly ridiculous is that we already had to fill all this horse**** out when enrolling in the insurance in the first place. Oh, and at the bottom, there's no option to get checks mailed directly to me. Only to the provider. Even though I've already paid, and paying up front is pretty common in these situations. And they call the provider a physician, which puts me in uncertain territory, since the provider in this case isn't an MD at all. I'll end up calling them once again to try to straighten all this mess out. Grr. I think I've spent more time on the phone with this farking insurance company than I have with my own mother. Once they finally decide to pay up, their coverage is great, but I honestly suspect that their entire business is based on the premise that if they make the process of collecting benefits difficult enough, their clients will give up. I actually wonder if this is the wrong form entirely. There isn't even a space on the claims form to enter the total amount that was billed. I wonder if this is specifically intended for injury scenarios. But if that's the case, shouldn't there be a type of form to handle more typical health care scenarios? -- monique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca -- To reply privately, take the X's out of my user ID. |
#4
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[OT] Why do insurance companies have to make things so complicated?
"Monique Y. Mudama" wrote in message ... Well, I have a receipt for a bunch of visits, and now I want to file with the insurance company for them. It's DH's company, so he printed off some paperwork, and I'm now trying to sort out how I'm supposed to fill this stupid thing out. 3) Any health claim form is acceptable to insurance co. (huh? What on earth does that mean?) There are standard forms that providers often use and to cut out some of the red tape, most insurance companies will acept then rather than insist of their own form Later, it says, "If you receive add'l bills in connection with this claim after you have mailed this form, PLEASE DO NOT COMPLETE ANOTHER FORM" Maybe they just mean if you get billed three or four times for the same office visit, they don't want all the bills. Now completely bewildered by the instructions, I move on to the claims form itself. Here it wants to know all sorts of non-pertinent details, like are any other family members employed. What? Huh? WTF does this have to do with anything? Oh, right, they want to check and see if your company will pay, instead. Except, no, they already have a checkbox for "occupational illness or injury?", so WTF? They actually want the address of my employer, too. If two family members are employed, usually a husband and wife but there are also other relationships recognized by insurance companies, each employed family member that is insured by their employer would normally collect on that insurance first. Their spouse/parent/domestic partner's insurance would then maybe pay the rest of the bill. I know. That sounds just as bad as their forms. It is just really hard to write instructions that cover all the bases. I can read and understand the Internal Revenue Code and Regulations but insurance can drive me up a wall. After many years of fighting them, for me and the kids and for my parents, I finally get a break. Everyone we see bills Medicare, then Medicare forwards the paperwork to our other insurance. Being retired military isn't all bad. Jo |
#5
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Why do insurance companies have to make things so complicated?
Monique Y. Mudama wrote: On 2006-04-04, penned: Monique, I would just fill it out as best you can and send it in with a photocopy of the bill. There's probably a lot of stuff on their standard form that doesn't pertain to your situation, but they try to make the forms as general as possible. So you can ignore whatever doesn't seem relevant. Don't worry about all that stuff about "is this a new injury" or whatever. Mostly they just want to see the bill, with a diagnosis code, number of hours, and the amount billed, plus your signature. Oh, and if you leave the part about "send the check to the provider" blank, the check will come to you by default. I've had doctors who don't do any of the paperwork either, and that's how it's done. The insurance co assumes they're sending the money to you, unless your health care provider agrees to defer payment until the insurance company coughs it up, in which case you would have the check sent to the provider. I think that's the minority of cases, though. Most providers who aren't part of a PPO or HMO, etc, don't want to wait for reimbursement from the insurance companies - that's part of the reason they don't join plans to begin with! Joyce Thanks, Joyce. I still think I will call them tomorrow, because I would rather have this done properly than wait months to get a mixup resolved. I will ask about leaving that part blank. I hope you are right. You probably are. I just have had enough experiences attempting to drag my money out of their claws that I hate dealing with them -- even though they eventually always pay up, and they do provide very good coverage. It just seems like part of their MO to make you work for it. OMG. Oscar is at the top of her cat tree, chasing her tail again. She will go a few circles, then stop and stare at the evil thing. She just managed to get a good chomp, but didn't indicate any pain (maybe all that fur kept her from getting very far). Now she's grooming it to within an inch of its life. Why do we even bother with cat toys, I wonder? -- monique, who spoils Oscar unmercifully Good luck with that. I hate dealing with insurance claims. If your health ins. provider is anything like ours, be ready to enter Phone Menu Hell, then be put on Eternal Hold when you finally get to a "customer service representative." Sometimes I think that's deliberate. They're hoping you'll just give up. :-( Sherry |
#6
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Why do insurance companies have to make things so complicated?
Monique Y. Mudama wrote: I'm seeing a therapist. Therapy is supposedly covered under our insurance, at a very good rate, but my therapist doesn't file the paperwork herself, so I have to pay her at the time of service and then get reimbursed by the insurance company. No problem. Well, I have a receipt for a bunch of visits, and now I want to file with the insurance company for them. It's DH's company, so he printed off some paperwork, and I'm now trying to sort out how I'm supposed to fill this stupid thing out. The guidelines for filing a claim: 1) A new claim is being submitted for a different family member (okay, that makes sense) 2) A new claim is being submitted for a completely different illness or injury (should I consider my mental health an illness or an injury? I don't think I'm either mentally injured OR ill! And does each separate session count as a separate little pathology being addressed, or is it all a part of the same thing?) 3) Any health claim form is acceptable to insurance co. (huh? What on earth does that mean?) Later, it says, "If you receive add'l bills in connection with this claim after you have mailed this form, PLEASE DO NOT COMPLETE ANOTHER FORM" (emphasis theirs). Okay, then, uh ... how exactly do I submit additional bills? Gee, they're curiously silent on that front. I think they mean for the same date of service. You can file one claim for each date of service. Now completely bewildered by the instructions, I move on to the claims form itself. Here it wants to know all sorts of non-pertinent details, like are any other family members employed. What? Huh? WTF does this have to do with anything? Oh, right, they want to check and see if your company will pay, instead. Except, no, they already have a checkbox for "occupational illness or injury?", so WTF? They actually want the address of my employer, too. I really think it's ridiculous that they make me fill out all of this information. What's particularly ridiculous is that we already had to fill all this horse**** out when enrolling in the insurance in the first place. Oh, and at the bottom, there's no option to get checks mailed directly to me. Only to the provider. Even though I've already paid, and paying up front is pretty common in these situations. And they call the provider a physician, which puts me in uncertain territory, since the provider in this case isn't an MD at all. I'll end up calling them once again to try to straighten all this mess out. Grr. I think I've spent more time on the phone with this farking insurance company than I have with my own mother. Once they finally decide to pay up, their coverage is great, but I honestly suspect that their entire business is based on the premise that if they make the process of collecting benefits difficult enough, their clients will give up. I actually wonder if this is the wrong form entirely. There isn't even a space on the claims form to enter the total amount that was billed. I wonder if this is specifically intended for injury scenarios. But if that's the case, shouldn't there be a type of form to handle more typical health care scenarios? Some companies have funky forms - I would just write in the pertinent info by hand and mark it "Provider has been paid by employee." and send it along with a copy of your receipt(s) and itemized bills. I am having a hell of a time with our INS company - they will only pay for one angiogram of my eye, per year. The only way to monitor my condition is to do an angiogram of the eye. At one point, I was having it done every 6 weeks...I am now down to every 6 months, but I am still fighting bills from last year. -L. |
#7
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[OT] Why do insurance companies have to make things so complicated?
On 2006-04-04, Jo Firey penned:
"Monique Y. Mudama" wrote in message ... Well, I have a receipt for a bunch of visits, and now I want to file with the insurance company for them. It's DH's company, so he printed off some paperwork, and I'm now trying to sort out how I'm supposed to fill this stupid thing out. 3) Any health claim form is acceptable to insurance co. (huh? What on earth does that mean?) There are standard forms that providers often use and to cut out some of the red tape, most insurance companies will acept then rather than insist of their own form Oooh. That makes sense. There were a lot of ways I could interpret that. I don't suppose that means I could just make up my own form with the actually important info and send that? *ponder* Later, it says, "If you receive add'l bills in connection with this claim after you have mailed this form, PLEASE DO NOT COMPLETE ANOTHER FORM" Maybe they just mean if you get billed three or four times for the same office visit, they don't want all the bills. Maybe. But I've had to fill out forms about chiro, an injured wrist, etc., and in those cases the entire chiro experience was one claim. If two family members are employed, usually a husband and wife but there are also other relationships recognized by insurance companies, each employed family member that is insured by their employer would normally collect on that insurance first. Their spouse/parent/domestic partner's insurance would then maybe pay the rest of the bill. Yes, but they have already harrassed me about my insurance status numerous times. It's excessive to ask me every single freaking time. Maybe they do this in case benefit plan periods don't match ... I know. That sounds just as bad as their forms. It is just really hard to write instructions that cover all the bases. I can read and understand the Internal Revenue Code and Regulations but insurance can drive me up a wall. Hehe. Yeah, I've read IRS instructions and, while long, they usually do make sense. After many years of fighting them, for me and the kids and for my parents, I finally get a break. Everyone we see bills Medicare, then Medicare forwards the paperwork to our other insurance. Being retired military isn't all bad. That's good. -- monique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca |
#8
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[OT] Why do insurance companies have to make things so complicated?
On Mon, 3 Apr 2006 21:44:20 -0600, "Monique Y. Mudama"
yodeled: To give you the short answer, I really, really believe that they make it so difficult because they hope you will give up and not file your claim. I am sure that this works in many cases. This was actually proposed in the 80s and 90s by the anti-welfare think tanks, as a way to discourage people from filing-- make the process so confusing and unpleasant that people will just give up and go away. So don't give them the satisfaction-- or what is rightfully yours. Tough it out and get what's coming to you. Theresa Stinky Pictures: http://community.webshots.com/album/125591586JWEFwh My Blog: http://www.humanitas.blogspot.com Make Levees, Not War |
#9
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[OT] Why do insurance companies have to make things so complicated?
On 2006-04-04, Kreisleriana penned:
On Mon, 3 Apr 2006 21:44:20 -0600, "Monique Y. Mudama" yodeled: To give you the short answer, I really, really believe that they make it so difficult because they hope you will give up and not file your claim. I am sure that this works in many cases. I believe this, too. It makes me so angry and sad. I know that I didn't keep on top of my insurance company when I was depressed, and I didn't get a lot of money they owed me because of it. If you're mentally or physically ill for an extended time, you're not in any position to fight paperwork and phone battles. And they damn well know it. This was actually proposed in the 80s and 90s by the anti-welfare think tanks, as a way to discourage people from filing-- make the process so confusing and unpleasant that people will just give up and go away. How do these people live with themselves? So don't give them the satisfaction-- or what is rightfully yours. Tough it out and get what's coming to you. I definitely will, no doubt about it. It just stresses me out so much to deal with it at all. -- monique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca |
#10
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Why do insurance companies have to make things so complicated?
On 2006-04-04, penned:
Good luck with that. I hate dealing with insurance claims. If your health ins. provider is anything like ours, be ready to enter Phone Menu Hell, then be put on Eternal Hold when you finally get to a "customer service representative." Sometimes I think that's deliberate. They're hoping you'll just give up. :-( Actually, this company seems to be pretty fast to respond, and their reps seem pretty competent. It's just that the system itself is so screwed up and extremely paperwork bound. Because they insist on sending you stuff in the mail rather than emailing or calling, it takes weeks to find out something is wrong, and then weeks again to find out if they actually fixed what they said they were going to fix. In the meantime, you're getting bills from various facilities for stuff that you *know* should be covered to some extent. And you have to ask them to please wait. They're usually very nice about it, because they know the game, but I still hate it. Every phone call wastes some fraction of my life. Grrrr. -- monique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca |
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