Battle with My Insurance Company

Wednesday, June 25, 2013

anger management

I smell blood.  I feel like a shark today and someone is about to get bitten…that someone will be whoever answers the phone at my insurance/health benefits company.  That unfortunate person is going to really get my wrath.  They haven’t paid me for 2 months worth of drugs/physio/massage services to a total of over $6,000.  My visa is due next week and I’m due for another set of $2,500 injections next Friday. I started phoning them asking for my money 2 weeks ago.

First I asked if they got my claims in the mail (unlike my husbands insurance and other more progressive insurance companies in which you can send your claims on-line).  They confirmed they received both my May and June claims.  When I phoned last Tuesday, they told me that they were still working on it….  “Someone will call me in 3-4 days”.

Well, no one called.  So I phoned 7 days later…”I’m sorry there is a  hold up on your claims”.  On Tuesday, at around 5:45 p.m., someone phoned me to tell me that “We are still working on it.”  Why?” I asked.  What’s the hold up?  I’m sorry …blah, blah, blah and then she made one critical error…she said something about cheaper medicine.

So as I was sleeping soundly last night, my brain was working overtime, concocting a plan to give them an earful they would never forget.  This morning, when I phoned them yet again, I was on a roll.  I want to speak to the person who is working on my claim and their supervisor.  I want their names and numbers.  “We don’t give out that information”, the woman told me.  “That figures”, I thought, “What are they afraid of?”

“Can I help you?”, she asked me.  “Sure,” I told her.   Get someone to phone me.  Tell them that the person’s job in the claims department is to process claims, not to find me a cheaper alternative drug.  That’s what my doctor is for.”  I also informed her that there is an alternative drug and it gave me a stroke, and the other drug my doctors were considering would cost about $6,000 a month, and would they rather pay for that one?  Furthermore, if they want an explanation about the drugs I’m on, maybe they should phone me and ask me.  I am so glad that my very important call was “Recorded for Quality Assurance” today.  They could use it for training.


I went to see my spine doctor for an appointment.  He said everything was good which I was happy to hear.  My spine is good, however, my feet are bad.  Whenever I have an appt. with him I have to fill out a lame patient questionnaire.  I sometimes wonder if anyone even reads them.  So today I was in the mood to play the devils advocate.  Here are samples of two of the questions and my responses.

1.  Are you satisfied with the results of your back treatment? extremely satisfied, somewhat satisfied, neither satisfied nor  dissatisfied, somewhat dissatisfied, extremely dissatisfied.

My answer:  I’m not dead and I can walk so I guess I’m extremely satisfied.

2.  Compared to before your treatment, how do you feel you now look?  Much better, better, same, worse, much worse.

My answer:  My back is now currently sporting 7 new scars that weren’t there before surgery.  I guess they look pretty good, but, because I don’t have eyes in the back of my head, I don’t really know.

After a 2 hour wait, I told the secretary I had another appointment with a pain doctor and would be leaving at 12:30 in order to make it there on time.  So I didn’t have to see a resident (which usually takes an hour more).  I gave my doctor a bowl of fruit and he said that was sweet of me.  I find doctors have little time to eat and are always in a rush because of their heavy schedules.  This guy is really busy and good at his job.  My friend Norma says if you bring your doctors and nurses food, they will be nice to you and remember you.  I will only give my doctors and nurses food if I like them.  That means the Dragon Lady gets nothing.

Thursday, June 26

Phoned the insurance company 3 times today.  Then decided to be a real pain in the butt and start sending them emails.

Email to Insurance Company

I have been trying to talk to a supervisor regarding the mismanagement of my claims.  I think it’s ridiculous that I’ve had to phone at least 6 times over the last 2 weeks to get my claims for over $5,000 looked at.  I finally got  one set of claims ($2600) processed for June but my May ones are still pending.  I was assured on Monday and then Tuesday that someone would phone me to discuss it, but no one did.  This morning I phoned again, and the person answering was hesitant about letting me speak to a supervisor.  Since no one phoned me back on Monday and Tuesday,  I insisted on waiting 20 minutes for someone to speak to me.  Last week when I called and asked for the person processing my claims or their supervisor, I wasn’t notified for 7 days.  If you are looking for a cheaper drug (ie: tamoxifen), I tried it and it gave me a stroke. So either process the claims or decline them so I can send it to my husbands plan.  I have to pay my visa by July 3.  How would you like to pay for the interest rates if I don’t get my money in time?

I was quite pleased with my email.

Later today…..Guess who just got her money?  It will be in the bank tomorrow.  Thank you very much.

Wonder if it was my email that did the trick or my comment about personally visiting them tomorrow to pick up my cheque?

Oh, and by the way, the explanation I was given regarding the delay wasn’t because they were searching for a cheaper, generic drug…it was because of my massage therapy.  Hmmmm.

This cartoons pretty much says what I wanted to say to the supervisor….


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s