“Hello, Mr. Kauffman? This is (censored) from (my HMO). I just wanted to give you a call to let you know that we’ve resolved the issue with your daughter’s PCP (primary care physician). The claim submitted in October 2004 will be resolved, and you will not be responsible for any charges previously billed by the PCP.”
“You mean the 10/1, 10/2, 10/3, and 10/5 claims that I called about last week; I believe it was 11/28 of this year?”
“I don’t have the exact dates in front of me. I just thought I would give you a call on my break to let you know the issue has been resolved.”
“But you think ALL of the claims from October 2004 will be resolved? What about the other dates that I was billed for? Specifically, I’m referring to the claims denied for July 2002, March 2005 and May 2005?”
“Sir, you didn’t ask us to check on any dates besides the October 2004 claim.”
“Au contraire, mon fraire. Claim… S. That’s CLAIMS… as in plural. When I called on 11/28 I noticed, and was concerned, that the representative was focused on 10/04. I asked about four claims for October 2004; PLUS, on three separate occasions I clarified with your representative that the bill from the PCP listed three dates of service OTHER than October 2004 – specifically: July 2002, March 2005, and May 2005. I see that my efforts were in vain.”
“Sir, my break is over. I’ve got to get back to the phones.”
Talking to my insurance company on the phone has proven to be an excellent source of energy. Now I just have to find a constructive outlet for that energy.