Humour? Or just venting?

[Bernice]

This perhaps belongs in laugh stop...

My wife and I are... fat. We need machines to help us breathe at night. Some parts need replacing from time to time. Insurance covers this. Usually.

My wife contacted her supplier back in June, and asked for some new parts, if and only if they were covered under our new insurance. The supplier agreed. The supplier shipped us a package on July 8. We checked with insurance. The claim was denied. She called them and asked why. It seems that the provider is physically outside our service area, and the claim that was submitted claimed that she physically picked up the parts from a retail store. She was informed that if the supplier re-submitted the claim showing the package was shipped to our home, that the insurance would cover it. Packages that are shipped to a patient are deemed to have a service address the same as the patient's residence.

About this time a bill from the provider showed up in the mail.

She called the provider, and explained that they needed to resubmit the claim, correcting the part about it being picked up in person. They said they would.

They re-submitted the claim, with the same error, and it was denied a second time.

They billed my wife again. She called them and offered to send the package back at their expense. They said they would send her a Will-Call tag and she could send it back at no cost.

No Will-call-tag was received.

Days later, another bill arrived. She called them, to report that the Will-call tag had not come. They insisted that my wife was liable for the return freight cost. She demanded to talk with a supervisor. She ended up talking with a person in shipping, who looked her order up and found that indeed, it had been shipped to our address. He promised to talk with billing and get it all straightened out.

A week later, another bill arrived. This time, to settle the issue, we took photographs of the package (still unopened) and screen prints of the tracking information on both USPS and UPS websites, showing that the items were indeed shipped to us. We sent these to the provider electronically. She instructed the provider to either correct the claim and re-submit, or issue a will-call tag for the package.

Another week went by.

Another bill has arrived in our mail yesterday afternoon, too late to call them the same day.

Part of me finds this hysterically funny. Another part of me feels sorry for the company, because despite their claims of providing world class service to customers, they have in their employ some people who are clearly either inherently evil or profoundly stupid. A third part of me is tired of playing games, and just wants to sue them for mail fraud and violations of the consumer credit protection act.

What would you do?

Hugs,

Bernice

[Davita]

Stop dealing with the people that can't do their jobs and contact the owner directly via certified mail and send a copy of your conversation to the better business bureau. Tell the owner that you sent a copy to the bureau.

Simply explain what is going on and ask the owner to correctly resolve the issue and ask how he/she will do it.

[Bernice]

I like that idea. I wonder how I find out who "the owner" is of a big faceless interstate corporation?

Hugs,

Bernice

[Requal Jo]

Hi Bernice.

I had a similar problem. Talked with the company for over 6 weeks and got no satisfaction.

In the end I addressed the mail to the General Manager of the company, with the letter and documents in an inside envelope marked confidential for General Manager eyes only.

I got an immediate reply with the issue corrected and an accompanied apology.

[Bernice]

I think that should be our next step. The company is now changing their story. They now say they were told by our new insurance to file on our old (expired) insurance, which they claim they did, and it was still denied. Of course, we have no idea why they would have been told to file on a company with which we no longer have insurance.

Hugs,

Bernice

[Ralitsa]

My suggestion is to not talk to them by phone.

Write a letter to the company's billing department with all the documentation, copy on the letter & documentation: your insurance company, the state insurance commission, the better business bureau of both the place you live and the place the company is located, and your state attorney general. The BBB's are optional but if they pride themselves on their customer service they will hate to get a bad review.
Most of those people you copy will ignore it and stuff it in a file somewhere, but seeing that all these other people were copied will put the fear of truth into the company and they will actually put some effort into getting it right. And I would be sure to inform them that submitting incorrect claims is mail fraud, not to mention numerous other state and federal laws that the insurance commissioner and attorney general might be interested in investigating, hence you copied them.

Another reason to do it in writing is that phone conversations almost never have any legal validity. Back in my younger days, when I could actually read the fine print, I did. And it always says that disputes must be submitted in writing.

Also, you might be worried that if you don't pay them then they will turn it over to a collection agency who will harass the hell out of you. However, collection agencies are legally prohibited from trying to collect claims that are in dispute. So if they do turn it over to a collection agency, then you copy the collection agency on all the previous letters and documentation and inform them the claim is in dispute. If they continue to harass you, then you send them a nice little letter and copy your state attorney general (who was copied on the earlier letter), informing them they are in violation of state law. Rumor has it that attorneys general love to beat up on collection agencies, because they win a lot of public approval for that.


All that seems like a huge pain, but six phone calls and still no progress seems worse to me.

Meanwhile you can go ahead and actually use the part you ordered rather than worrying you will have to send it back.