bellefior (bellefior) wrote in bad_service,

Why I Hate Insurance Companies

My claim for a fairly expensive medical procedures (over 15K) was reprocessed again by our secondary insurance company--after being initially denied because they didn't have the explanation of benefits from my primary insurance denying the claim, understandable. Once again, it was denied. 

Want to know why?

Because once again, supposedly, they didn't have the explanation of  benefits from my primary insurance denying the claim.  Even though when the Customer Service Rep looked for it, he found it in their system, and couldn't figure out why they didn't see it when it was reprocessed. That's right, it was in there, and  the idiot who processed the claim for the second time either forgot to look for it or didn't see it! 

He transferred me to a claims service person, who confirmed that yes, the EOB was in there, said that she would submit the claim for "reconsideration"  and mark it urgent, and it would be reprocessed within 10 days. 

Let's hope they get it right this time.  I mean, how hard can this be? You have the EOB from my primary denying it, you admit that you had it on file, so process the damn thing correctly.  I basically told her that the first time, I could understand them denying it because they didn't have the primary EOB, but the second time, they really had no excuse for it, especially when they looked into the system they saw it in there and couldn't figure out why it happened!  Someone is not doing their job on their end.  Normally I wouldn't care, but it is for 15K, and I hate seeing EOBs that say I am responsible for it, when I know I am not.

I hate the new insurance my husband's employer switched to.  We didn't have any of these problems with his old insurance.  

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