October 30, 2009

Communication is Key!

Filed under: budgets,crazy,insurance,money,network,websites — by elysianconfusion @ 6:44 pm
Tags: , , , , ,

I’m still struggling with the dermatologist bill. When I checked, the doctor’s office had resubmitted the bill for another provider to see if that would pay more, and then they wrote to me and said it didn’t work, that the other provider billing gave them less money.

So I logged in to check my claims, and they didn’t give *less* money. They gave *no* money. They denied the claim as a duplicate (which it was, so that’s legit).

Then I called PHCS at the suggestion of my HR department. PHCS agreed that the (original) doctor was in-network and a covered provider. I said great, can you tell Guardian that? They said no. They cannot call Guardian or communicate with them in any way on my behalf. Explain to me how that is useful or efficient? The only thing they said I could do was to call Guardian and ask them to submit the claim again, Guardian would then send it to PHCS to determine if the doctor is in network and theoretically *this* time they’d say yes, she’s in network and a covered provider, they’d pay the doctor’s office and I would stop getting billed.

I asked if there was anything else I could do, since this process obviously hasn’t been working since July, in spite the doctor consistently being listed on the website and via phone and as confirmed by the doctor’s office. No, nothing else to do.

So I called Guardian again. They asked if PHCS had provided me with something (a form?) and said that’s what PHCS usually does when things don’t work like this, but since they didn’t and weren’t planning to do so, they’d submit the claim again for research. If I’m supposed to call PHCS to confirm that the doctor is covered, why exactly is it that Guardian and PHCS can’t call each other?

I have a feeling that I’ll be paying this bill.


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