Patrick F (rainbowxgeek) wrote in bad_service,
Patrick F

I was with Wellcare Insurance from 1 November 2012 to 31 January 2013. In that time, I had more issues than I had in more tha 5 1/2 years with Medicare and Medicaid. It should be noted that with the plan I was on, I was to have ZERO liability for in-network providers. No copays (barring prescriptions), no deductible, no co-insurance, not even for ER or specialists (this becomes important at the end of this post).

I have a laundry list of issues with them. One is, I'm constantly misgendered. My name is Patrick. I tell them, every time I call, I AM Patrick. I'm still called ma'am near constantly. One rep, I have to assume she was doing it on purpose, because I corrected her more than 5 times and it continued.

I went on the website, looking for a network opthamologist. I have blepharitis (a chonic eye infection) and was having a flare up. It wasn't emergent, but I still needed to see a doctor for optical antibiotics. The website showed zero opthamologists within 60 miles. So I called. The rep's computer had the same result, so they filed it as an expedited grievance so I could see an out of network opthamologist. Was supposed to hear back within 24 hours. Called to follow up, and the grievance ID number I was given was incorrect. It turns out that, for whatever reason, that specialty doesn't show in the computers--there are a bunch in my area. So let me recap that--this specialty does not show up in the insurer's customer service center's OWN computers.

Over the holidays I (like pretty much everyone I know) was sick. On Christmas Eve, after more than a week of getting worse, it was becoming clear I needed antibiotics. I called to verify which urgent care facilities I could use, because the one I'd been to, I expected problems with the PA prescribing antibiotics. The only other one listed in the computer (which we now know is untrustworthy) was inaccessble to me because of transit issues.

The rep told me I could go to a place I'll call XYZ Physicians. I've been there, it's a bt of a pain to get to for me, but the treatment is usually good. So I went. I took a cab, because the bus would've resulted in half a mile walk, which frankly, I didn't feel well enough for. I get there, and they tell me they don't take my insurance. Bear in mind, the insurance told me I could go there.

I was ready to leave, but someone (amazingly) offered to pay what I thought was the full self-pay bill for me. So I consented to treatment. Few weeks later, I get a bill from XYZ for over $100. Turns out what the lady paid was just a portion of the self-pay fee.

So I call Wellcare. I understand that I consented to self-pay treatment, though I honestly didn't realise there would be an additional fee on top of what the lady paid.

I filed a grievance, related to this bill, as I wouldn't have gone to XYZ if the rep hadn't named them as one place I could go (and I even specifically verified the address, as they have multiple sites).

Get a letter today, that they contacted XYZ who advised them that I was advised they don't take Wellcare and I was seen as a self-pay patient (ie: what I told them when I filed the grievance!) and that they have not received a claim for processing.

Well, duh, since XYZ didn't TAKE the info, since they don't take my insurance. I called to find out if I need to self-submit a HICF (Health Insurance Claim Form), not an uncommon occurrence with out of network claims. The best she can tell me is to follow up with "my grievance coordinator". Uh huh. I don't have one. I never talk to the same rep more than once. She has no useful advice so I finally tell her that I STRONGLY suggest she get a supervisor on the phone and get me a damned answer or my next stop is the state insurance commissioner.

Supervisor comes on. I ask HER if I need to submit a HICF. She says I can't. Which I find odd. I point out that the provider won't bill them for me. I reiterate that my next stop is the state insurance commissioner. She puts me on hold again. Finally comes back with, they'll contact the provider to request some form or another and the bill will get paid.

I'm not holding my breath.

Finally, I got a bill from my psychiatrists office and eye doctor. Remember the zero liability part? I'm not supposed to have bills. So I call, and get told that they need to bill medicaid for the balance. I'm rather confused, as my benefits coordinator told me Wellcare replaced both Mediicare and Medicaid.

So I call the eye doctor, they say no problem, I give them the info. Let's see if Medicaid pays (I just gave it to them this week). Call the psychiatrists office. She doesn't take medcaid.

So Monday I'm calling wellcare back. I can only deal with one issue at a time when I call (for my sanity, not anything on their end) and tonight's call was about the issue with XYZ.

I'm so over them.

By the way, I hate talking on the phone. Part of my anxiety disorder. I've spent more time on the damn phone with them than I have with my family.

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