First, I have to apologize to the monkeys. It's unfair of me to compare them to the morons who work for a certain major health care coverage firm who couldn't find their collective @$$es with all hands and a map. To the primates out there; I sincerely apologize. To Big Clueless & Big Headache; your a bunch of @$$hats.
The background on this: I have insurance with Big Clueless & Big Headache through my company (now COBRA). The provider I use is not part of the network and does not file claims. The patient does the filing and gets re-embursed for the out-of-pocket fees, etc. No big. I call Big Clueless to get the info I need in order to process the claims.
BC: This call may be monitored or recorded for training and auditing purposes.*
*yeah right, because if you trained your people, I wouldn't be going through this for the THIRD time in less than a year (but this is round one).
Me: Hi I need to double check that I am sending this claim to the DALLAS office and that this is the correct address and where it should be directed.
I spend ten minutes on the phone with Miss-for-$7-an-hour-what-do-you-expect-from-me? confirming and repeating the address. Fairly secure in my comprehension of where to send the claim, I fill out the paper work and mail it. Did I mention that it was to go TO THE DALLAS OFFICE??? *this is a BIG point.
Several (and I do mean several) weeks latter Big Clueless' ST. LOUIS office sends me a letter stating something to the effect "We do not process these claims at our office. We are returning it to you. This will be forwarded to the DALLAS office for processing". Anyone see something wrong here? Yeah, the St. Louis office will be forwarding the claim to the Dallas office, which had forwarded to the ST. LOUIS office for some unknown reason. I needed a drink after figuring out this circle-jerk approach to the processes. Nothing was returned to me...and I did not hear from them again until two months later when I had another claim to process and still had nothing from them on my first claim.
Now I am pissed and as anyone who has ever been within the line of sight of me when I get pissed will tell you...it ain't pretty. It will go ugly early, there will be collateral damage, deaths may occur, no prisoners will be taken and no quarter given. But on the plus side, if you ever want to be upgraded to first class because some asshat in reservations sandwiched you in-between two fat-assed business men in coach and you spent the entire trip sitting on one butt-cheek while trying not to get felt up by fat-ass #1....I'm your woman.
I called Big Clueless to find out what was the problem. The first three phone calls reveled to me the level of idiot I would be dealing with because three separate customer service reps couldn't even find me in the system...nor the company I worked for, even though it is one of the largest conglomerate health care systems in the US. I pop a Xanx and try to breath deeply. Oh and could I call back and see if someone else could find me in the system? Seriously? Your telling me you are to lazy to help me get to the bottom of this and could I just spend another hour languishing in muzak and phone system hell until I find someone else with four more brain cells than you to help me figure this out? GAME ON.
This is WAR. Finally after two hours and several people latter, Big Clueless finds me in the system, but not the claim I had filed. Yes, I had sent it to the correct address and the correct department and no, they have no idea why it was sent to the St. Louis office from the DALLAS office and could I now fax them a copy of the claim. I take another xanax and fax them a copy
Two weeks latter I get a letter..........."We can not process this claim at our office and are forwarding it to the DALLAS office......" I think a coworker peeled me off the ceiling. I don't remember, my memory is a little hazy. I think there was a tranquilizer dart involved, but I can't be sure. People at work begin talking in hushed tones when around me and several new people won't approach me.
I am now on a first name basis with several customer service representatives at Big Clueless (and I don't think I will be getting a Christmas card from any one of them....a restraining order: yes. A Christmas card: no). Several rounds of phone tag and refills of my Xanax RX, it is finally discovered that they (the DALLAS office) need the provider ID number to process the claim.
1. There is NOWHERE on the claim form to impart this piece of information. I am not Deon Worwick and do not have psychic abilities that would enable me to know that this will be a key piece of information in the processing of this claim (and future claims, but more on that latter).
2. No one at Big Clueless ever contacted me requesting this information. No phone calls, letters requesting that I send them the info, calls to the provider requesting her ID number. Which leaves me to believe that they just threw the claim in a corner and thought that the ID number would magically appear or I would just forget about the claim. Right buddy! You got my money and I'm going to forget that? If you are sitting on money I could potentially be spending on a new handbag, you bet your fat-Big-Clueless ass I am not forgetting it!
3. Big Clueless employees people who can not think outside the box and do not go "above-and-beyond" anything not in their job description.*
* Which makes me wonder because every one of my job descriptions had the cover-all written into it that says "And other duties as necessary or assigned" Which was there in order for the boss to nail your butt when you didn't do stuff like...contact the member for a crucial piece of information in order to get the claim processed....
After a number of phone calls I get the information I need and a supervisor on the phone. I have a "small" chat with the CS supervisor about the F*%kwittages she has working for her. Provider ID number is given and claim finally gets paid. All this pain and suffering is now over and they have the provider ID in their system. End of round one.
Oh So WRONG.