by Ashley
Don’t you just HATE dealing with insurance companies? It feels like you always get the runaround and then nothing is resolved in the end! Ugh!!
Well I (unexpectedly) actually had a positive experience this past week!
I had two separate issues I needed to speak with a representative about.
- Mayo Clinic bill
- Prescription Reimbursement
Regarding the former (Mayo Clinic). We all remember how we owe the Mayo Clinic money for services rendered to Chris when he had his mystery illness at the end of 2013. Well, even though Mayo Clinic is out-of-network for us, our insurance pays a flat rate of $100 toward the service. To have this happen, Mayo Clinic must send a bill to our insurance (Blue Cross Blue Shield of Arizona), then BCBS sends ME a check for $100 and a statement of benefits. I then send payment and the statement of benefits on to Mayo Clinic and set up a payment plan for the remaining balance owed.
I have had a HELL of a time getting BCBS to send me this information. Every time I call they say they haven’t received anything from Mayo Clinic. I call the Mayo Clinic and they cite exact dates they sent the information; verify address, fax number, etc. Everything is correct.
So after receiving yet another bill from Mayo Clinic (we are 4 months past due at this point), I call BCBS and – shocker! – they say they have not received a bill from Mayo. Exasperated, I explain my situation: This bill is becoming delinquent, I can’t set up a payment plan until they get the information from you, they say they’ve sent the information multiple times, etc. What do I do????
Unlike in the past, where I’m told simply to call Mayo Clinic and tell them to re-send the bill (for the umpteenth time), this time the representative put me on hold and called Mayo Clinic personally!!! When he came back, he explained the problem (they had included the subscriber number, but not the group number, so it was never “matched up” to us in the BCBS system). They rectified the problem and are getting everything processed immediately. YESSSSS!!!!!!! One step closer to actually being able to set up a payment plan and start working on that debt!!!
In reference to issue #2 (prescription reimbursement). When we went back to Texas for Christmas, I had accidentally left my prescription for birth control in Arizona (a little personal, but relevant since it was not a prescription I could “do without”). I was NOT about to mess up my cycle, risk getting knocked up, etc., so when we arrived in Texas I promptly called in a refill and paid out-of-pocket to get it. I had to pay out-of-pocket because I was refilling it before it was time, but I was told I’d be reimbursed by insurance because I wouldn’t need to refill it the following month (once I returned to Arizona I obviously still had the prescription there, so I had more than enough).
So I sent in my receipt and the appropriate paperwork back in February to be reimbursed. And just this last week I got a letter denying my reimbursement with the explanation “75% of medication must be used before a refill can be processed.”
So I explained the situation to the BCBS representative and asked if anything could be done, or if this was the final word. He was so kind to explain that “YES! You can definitely challenge that letter!” and he even told me basically word-for-word what to write in the letter, and where to send it!
Now, there’s always the possibility that BCBS denies my request again (insurance companies never make it easy, do they?), but I was so happy and pleased with the service I was given by this particular representative. Wooo!
So, fingers crossed I get the check from BCBS for Mayo Clinic AND I get reimbursed ($55.99) for a prescription I filled way back in December!
I’m fighting the good fight. It’s time versus money over here, and my $100 for Mayo Clinic and $55.99 for a prescription feels like a LOT of money right now…..and at this point I guess I have more time than money, so its worth it! : )
