Rethinking my plans
Jan. 20th, 2004 08:58 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
bronwynrhObviously, I'm on the wrong career path. I should have been an insurance claims adjuster, as I am very clearly better at understanding the rules and regulations and restrictions of this crap than the idiots over at MegaDeath.
Excuse me, that's MegaLife.
Hi, you only covered $56 of this $66 charge from one of your preferred providers. Why?
Well, we only pay the Usual and Customary charges. $56 is the U&C for that kind of, of visit.
Dr. W. is contracted with MegaLife, though. He is a preferred provider. Therefore, as it says right here in your little booklet, he should be covered at the Preferred Allowance, NOT U&C.
Hold on a minute. . .
Uh huh. . .
Ok, yes. He is covered at the Preferred Allowance. You are not responsible for the balance.
*sigh* Right. That's what I said.
And how about this neurology visit? I've been seeing this doctor for over a year, and although he's not contracted with you, he's the only game in town. I have no choice but to see him. Therefore, per MegaLife's policy, he is to be covered at the Preferred Allowance for Preferred Providers.
Um. . .
Look, I've had to call in about this every single time I see him. There should be a note in the file regarding this.
Um, ok. . . I'll put a note in the file about this and send it back over to the claims adjuster to pay the rest.
Right. (Thinking to myself, "Now how many times have I heard that before?")
Also, these hospital charges from Oct. 15. . . there's a $12 charge on there for pharmacy. That was the IV and medication. Why was it deemed an excluded educational service? I was being drugged, not educated. I called about this last week, but thought you might have better answers than the last rep I spoke with.
Ohhhhh yeah. It says on the bill that it's pharmacy.
Uh huh, so why this ED exclusion? The hospital is going to be calling MegaLife about this.
I'll send this one back over, too.
Yeah, thanks. (Again thinking, "Didn't I hear this last week? Didn't they still fark it up? Oy.)
Friends and casual stoppers-by, if you heed nothing else I ever tell you in this forum, heed this: Avoid MegaLife like the plague. They do business for independents and self-employeds, so some of you may encounter them someday.
Run. Run far far away.
Excuse me, that's MegaLife.
Hi, you only covered $56 of this $66 charge from one of your preferred providers. Why?
Well, we only pay the Usual and Customary charges. $56 is the U&C for that kind of, of visit.
Dr. W. is contracted with MegaLife, though. He is a preferred provider. Therefore, as it says right here in your little booklet, he should be covered at the Preferred Allowance, NOT U&C.
Hold on a minute. . .
Uh huh. . .
Ok, yes. He is covered at the Preferred Allowance. You are not responsible for the balance.
*sigh* Right. That's what I said.
And how about this neurology visit? I've been seeing this doctor for over a year, and although he's not contracted with you, he's the only game in town. I have no choice but to see him. Therefore, per MegaLife's policy, he is to be covered at the Preferred Allowance for Preferred Providers.
Um. . .
Look, I've had to call in about this every single time I see him. There should be a note in the file regarding this.
Um, ok. . . I'll put a note in the file about this and send it back over to the claims adjuster to pay the rest.
Right. (Thinking to myself, "Now how many times have I heard that before?")
Also, these hospital charges from Oct. 15. . . there's a $12 charge on there for pharmacy. That was the IV and medication. Why was it deemed an excluded educational service? I was being drugged, not educated. I called about this last week, but thought you might have better answers than the last rep I spoke with.
Ohhhhh yeah. It says on the bill that it's pharmacy.
Uh huh, so why this ED exclusion? The hospital is going to be calling MegaLife about this.
I'll send this one back over, too.
Yeah, thanks. (Again thinking, "Didn't I hear this last week? Didn't they still fark it up? Oy.)
Friends and casual stoppers-by, if you heed nothing else I ever tell you in this forum, heed this: Avoid MegaLife like the plague. They do business for independents and self-employeds, so some of you may encounter them someday.
Run. Run far far away.
