I spent about an hour on the phone (btwn yesterday and today) with my former employer’s benefits representative for Blue Cross Blue Shield. The insurance company denied covering blood work done the day of surgery (to make sure it was ok to do surgery). They said it was “routine” blood work, and I am only allowed one set of tests a year from my ob/gyn. Small problem… this was my dermatologist, not my gynecologist.
Yesterday’s rep said even though the gynecologist’s name is nowhere to be found on the claim document, this charge came from his office. Today’s rep said she doesn’t know what yesterday’s rep was smoking (my words not hers. she was much nicer than that).
Anyway, the charge was from the doctor on the claim form (imagine that), and now the rep’s got to go back and get a new claim code and resubmit the paperwork for adjustment.
I don’t even want to guess how much time, money, and manpower (besides my own) will be wasted in the course of fixing this debacle.
But this is exactly why I do what I do now…and why we’re going to win.