Thursday, March 17, 2011

Oh, "And.Them."

Me: "So, should I continue with the treatment
you are going to deny?."

"And.Them" Customer Service: "I am sorry."

Me: "How do you people sleep at night?"

And.Them.: "I don't make the decisions, ma'am."


Okay, I let And.Them get the best of me today. I normally stay calm and collected; however, there reaches a point where enough is enough.

My point came today.

I called "And.Them" to check the status on my claims since I am on the Shore with my family instead of in Roanoke. The first person I talked to tried to tell me that she did not have access to any of my medical records. After nearly pulling my hair out with her inability to answer any questions, I questioned how they run a business where no one operates on the same system. Frustrated, I asked to be transferred.

Once transferred, I was required to give all of my information again. This woman claimed she did not have my mailing address on file. "That's pretty ironic since you send me mail."

I ask to be transferred again.

I reach this woman who tells me that my surgery was approved but since I have a pre-existing clause on my policy, the surgery has been denied. I explain to her that I understand I have a pre-existing clause...Someone told me that back in December. Following their guidelines I have had my doctors provide them with my medical information which bluntly states that my cancer was not known prior to January 2011. I explained that I have played by the rules and continue to get the run around...

"Ma'am I do not see how we are giving you the run around."

So, I lost it.

I (loudly) explained to her that I have filed paper appeals, I have had my doctors send in my medical reports, I have pre-authorized procedures that actually are not required to be pre-authorized, and I have dealt with this since December and continue to hear a different answer every time I call.

I know she is limited in what she can tell me, I know she has a greedy boss who would fire her if she showed any sympathy, but my god...I already have cancer. Do I really need the extra stress of being hassled by my insurance company?

After the third time I requested to speak to her supervisor, she transferred me.

I received a voice mail.

Assuming I would never hear from the supervisor, I called the woman who originally approved my surgery.

Voicemail.

About 2 hours later my phone rings...It is the supervisor.

Shocking.

Obvious that she is calling to smooth my feathers, she shows a great deal of sympathy. She reviewed my information, and I quote, "You were diagnosed after your coverage began. This is not a pre-existing condition."

Duh.

She was actually very nice, very sympathetic. I made sure to let her know that the lack of organization does nothing to prove what a "great" company And.Them is. I mean, not even having my mailing address on file? Is that really how they are going to try to get me off the phone?

Nice try.

Don't screw around with a pissed off woman...Haven't people learned that by now?

She is supposed to be calling me back tomorrow. She said some claims are showing as being approved even though I have received letters saying they are denied. Again---lack of organization..........

I honestly do not know why they aren't sued often. Or maybe they are. I now understand why.

2 comments:

Dr. Jennifer Feeny said...

You are too kind with the name "and.them"! Your new blog should be IhateAnthem.blogspot.com!

Mrs. H said...

I'm glad you got through to their supervisor! I don't understand how companies can operate like that with such disorganization. It's downright pathetic and SORRY. Way to go for standing your ground (not that I'd expect any less!)