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Thursday, January 27, 2011

Now that's some efficient health care!

Posted on 9:49 AM by Unknown
Just had a really bizarre complete waste of my time... Our family practitioner's office called me and said a bunch of claims for my wife and my son were denied -- from 2009. I don't even have the same insurance anymore. The explanation on the EOB was "do not provide that service", and apparently the insurance company told the provider that I would have to call.

So I'm fuming of course... I mean, 2009?! WTF? Luckily I didn't really have to wait on hold, although, the phone menu wanted to fuck me over, but mercifully I got to a point where I could just mash 0 and get to an operator. Talked to the person a bit... apparently there were only two "claims" (although the one on my son was apparently a whole bunch of separate claims that got lumped into one or something) that had failed to go through because there was a computer error while the claim was being submitted.

Yeah, that's it. A short-term computer glitch. All that needed to happen was for the insurance company to resend the claim to their computers.

So I have two questions: What kind of shit-ass IT setup do they have where if there is an intermittent network error while processing a claim -- and it appears to have been internal to the insurance company, no less -- that it requires the intervention of no less than three humans in order to recover? And second, why couldn't the insurance company just work this out with my health care provider?

In a perfect world, the system should have recovered automatically. Transmission error during claim submission? Okay, retry! Failing that, it should have been one phone call between my health care provider and my (former!) insurance company. I mean... really?

Single payer, man, single payer. It's looking better every single day.
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