Well now this is frustrating

[nohanii]

So I got a call from my doctor's office. Apparently, my health insurance won't pay for my last visit -- I had to get my white blood cell count re-checked a month and a half ago after a latent infection. Now, I know I'm covered. I've been having problems like this since I was re-admitted for coverage in June. I called the insurance company to talk to them about it. They pulled up my file and said that yes, I am covered. They directed me to call the Human Resources department of my father's company to make sure there wasn't a problem on their end. I called, gave them my information, and they confirmed that, yes, I am covered on their end as well. Next step, I called the doctor's office back and told them what I had just gone through -- both the insurance company and the HR department confirmed my coverage, so it had to be a problem on their end. I told them they needed to call the insurance company for confirmation, because this was obviously their problem. There, problem solved.

Right?

Nope.

They called me back a half hour later and left this message:

"I think there was some confusion on the information umm that I--we had exchanged today. Pretty much when I called this morning to check the status of  a claim for your uh visit on 7/14 I had informed you that the claim is on hold because the insurance the insurance is requiring a full-time student status. You do show you being covered on the plan, being an active member on the plan, but umm they won't process the claim regardless of your eligibility because they want to know if you are a full-time student which you had stated that you had graduated last year or at least early this year.  And so umm the insurance, they are not going to pay the claim because of not being able to show that you are still a full-time student. That is the information I that was given early and also I called them just now. It's not a matter of being eligible, but it's a matter of proving your full-time student status, and since you graduated, they will not be able to pay for the service."

So essentially, I'm eligible to be covered but I'm not covered because I'm not a full-time student, so I;'m ineligible? What? Methinks the insurance company needs to train their employees again. I am correct in thinking that the healthcare bill passed by Congress several months ago extended a parent's medical plan to cover and child of 26 or younger, regardless of student status, yes? We went over this months ago. Our insurance decided to be responsible by implementing this particular bit of reform with the new quarter (which started in June, I believe) on an opt-in basis. We opted in.

So why is this so hard to get right?

Comments

[roie.livejournal.com]

Oh, God, insurance companies kill me. I used to work in a doctor's office and I swear, if you'd call and talk to someone they'd give you a different story from the next person. Nobody would ever get it right. I say call again and talk to someone, make sure to take down ALL names and times that you've talked to them and what they told you so that if they continue giving you problems you have a record of who said what.

[honeystix.livejournal.com]

We just keep getting different answers depending on who is the person making the call, not the person on the other end. I think what happened is the receptionist led with the fact that I'm not a full time student, so the insurance automatically said I wasn't covered. She should have asked me to just look up my file. That would have resulted in the same answer I get when calling the insurance. I'm just going to have the insurance company fax me and my doctor's office proof of coverage. Hopefully that will put an end to this issue.