with an insurance company today, trying to get them to pay a significant amount of money they owe to me.
It sort of went like….
Maybe some context might be useful here.
Recently, two insurance companies I am in network with decided to work together.
As a result of this arrangement, Insurance Company A is responsible for:
1. Receiving my claim.
2. Making sure the claim is error free.
3. Passing the claim on to Insurance Company B with a determination – either pay the claim or deny it.
Insurance Company B is responsible for:
1. Writing me a check for the claim
2. telling me the claim is denied and the reasons why (they usually fall short on that second part)
Here’s the little nugget that ties it all together:
They are not allowed to talk to each other about the claims they share.
That’s right. They cannot have conversations about claims. The only thing Company A can do is resubmit claims that people say Company B has not paid.
Now if the system were perfect this wouldn’t be a problem. When my painful journey in trying to get paid began two months ago (one month after I submitted the original claim), I discovered that Insurance Company B inexplicably loses claims submitted to them by Insurance Company A on a routine basis.
Because Insurance Company A cannot talk to Insurance Company B about the claim directly until after the third “failed attempt”and they are not allowed to resubmit a claim until after a set time frame, it can take up to 3-6 months before a problem is solved. After the problem is solved, it can take another two weeks until a check is cut.
This left me in the unique position of:
1.Having to provide Insurance Company B with all the constructive feedback Company A has about how Company B can solve the problem
2.telling Company A how Company B feels that how they are passing claims on is the real issue.
Kind of reminded me of this…
The scene entered my thinking at the 25 minute mark of the last phone discussion I had with the Insurance Company B representative who spent most of her time confirming every painful detail of each session on the claim. In between her thought provoking and insightful questions, I kept pleading for an explanation as to why she could not call Company A directly to solve this problem. She would respond by apologizing for the policy and offered promises of excellent customer care in return for my compliance with the interrogation. At one point I think I said something like:
“Just give me something that helps make sense of this…even if you have to lie to me…please.”
In the end, Company B acknowledged that they did in fact have the claim Company A sent them but could not explain why no one bothered to look at it in the two months it was in their possession.