[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

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.

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

pictures: http://www.bounceswoosh.org/rpca

"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

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

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.

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

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

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

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