Quote:
Originally Posted by Amail
From what I've gathered, the problem doesn't seem to be that the claim is denied.
My plan is administered in Maryland, where we've got a sister company. It was cheaper for us to get coverage by joining their plan, I suppose.
Where it gets tricky is that their office (says they) cannot pay claims to out of state claimants. Instead they submit the claim to a California BC/BS office, who makes payment.
According to their records, somebody in the Maryland office did issue a check. There are notes that say the check was intercepted before it was sent out. Presumably this was because they are not supposed to issue out of state checks. Now they say that the California office says they sent a check. Nobody's received a check.
You'd think it would be a simple matter to put a stop payment on the check, wait a few days and check to confirm the check has not posted, then re-issue a new check.
But Noooooo, that's too easy. They need to open a Case File™ so that it can be investigated. There's no set time the investigation has to conclude - I suspect this is another of the "float" techniques.
Also, I cannot speak with the CA office handling the payment because they are not my provider.
So, the game seems to be point fingers back and forth claiming that they're doing their utmost to service their customer by opening a case.
It sickens me.
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I'm in a similar situation. What you say is true by what I know. However, the medical center should have a billing entity and there should be a customer service manager there. I got a hold of this person located in Orange County and she was very efficient. She in not a BC/BS employee. She works for the big company that owns many hospitals and med centers.
I didn't mention lawyers, I just said I had a complaint and wanted to make it "formal." Using the terms "formal complaint for the record" seems to be my best trump card in the last couple of years. No raised voices and no extended conversations. I tell them all the discussion should be in the complaint and I want a copy in letter form.