The following conversation takes place between me and United Healthcare.
It is true, it is accurate. I couldn't make this one up.
From this moment on I will refer to me, Tracy, funchaos.
Tracy will refer to Tracy, UHC representative.
Tracy: Thank you for calling United, this is Tracy, may I please have your name.
Tracy: Yes it is.
I: No, my name is Tracy also.
Tracy: Hi Tracy Also, may I verify some personal information with you please, what is your subscriber ID #?
I: (chuckling) Yes, my member ID# is 55555555 and my name is Tracy Ko...
Tracy: I am sorry ma'am I do not have a member ID # 55555555 for a Tracy Also
I: I am sorry, there has been a misunderstanding, my name is Tracy K0%(!#
Tracy: Ok, yes that is the name on the account. (This is where we accurately verify more personal info) How can I help you today?
I: I am calling about a bill and an explanation of benefits that I received for my daughter Katie and my son Jason. (We verify the date of service and provider)
Tracy: What seems to be the problem?
I: I am curious as to why I am getting billed for this service and what the code on the bottom of the EOB means?
Tracy: The code EJB means that we need proof of pre-existing conditions and that is why we have not paid the bill and you are receiving it.
I: Ok, but this was for a stomach virus, not something that would be a pre-existing condition.
Tracy: I understand.
I: ok, what do you need from me?
Tracy: What we need from you is a letter certifying you had prior insurance coverage
I: What does a letter about having prior coverage have to do with having a pre-existing condition?
Tracy: Is this a pre-existing condition?
I: No ma'am is was a stomach virus, you just said I needed a letter certifying prior coverage because you won't pay the bill until you have proof of a pre-existing condition.
Tracy: I am sorry ma'am. Code EJB means we need proof of pre-existing coverage.
I: Ok, prior coverage from when?
Tracy: Your policy with us started on 2/1/2008. We need proof that you had insurance prior to this?
I: The claim in question is from after that date, it is from December 8, 2008
Tracy: Yes, however, we need to make sure you had continuous coverage prior to this before we can pay the bill.
I: You need to make sure I had coverage before February to pay a bill for lab work from December?
I: I have had insurance with you guys since Sept. of 2005
Tracy: My records indicate your insurance began 2/1/2008
SILENCE (I=slightly wore out and tired of this conversation)
I: What do I need to prove to you that I had insurance through you since 2005?
Tracy: Have you had a different employer from 2005 to 2/1/2008?
I: Yes my husband has, but we had united health insurance with both.
Tracy: Yes, but your group # is different with different employers..
I: Ok, can't you just look in your computer and see we had insurance with you under a different group?
Tracy: No, sorry.
I: Ok, what do I need to do in order to get this bill paid?
Tracy: You need to provide us with proof of insurance.
I: How do I do that?
Tracy: We should have sent you a certificate of prior coverage when you cancelled your previous insurance.
I: Ok, let me look (searching to no avail)
I: I can't find a letter. Is there anything else I can do?
Tracy: You can call customer service and request another letter be sent to you.
I: Aren't you customer service?
I: Can't you then just look it up?
Tracy: No ma'am, that is not my department.
I: Can you just call the other dept. and get a copy of the letter from them?
Tracy: No, only you can do that.
I: So let me get this straight, you need a letter from yourself proving that I have had insurance with you from before February 2008 for a claim from December 2008?
I: Furthermore, if I do not have this letter than I can call you and get a copy of this letter.
I: But you can not look up this letter yourself
Tracy: Sorry, we need to have a printed copy of this certification.
I: What happens when you get this letter
Tracy: We will list the information under this group number
I: Can you just look up the information on another computer and put it under this group #
Tracy: No, sorry
I: But, your dept. can look up this information?
Tracy: Yes, but we need a printed copy.
I: Do your computers have printers?
Tracy: I'm sorry?
I: Sorry, it just seems if your dept can give me the information that I need and you have access to printers, then why can't you just pull the information off your computer, print it and then re-enter the information into this group number?
Tracy: I am sorry, I am not authorized to do that.
I: Ok, just to clarify, I need to send you a letter, that I can get from you if I do not have it, to show you that I had insurance with you so you can input that letter back into your computer.
Tracy: That is correct
I: But you can not just copy that information from one screen to the next.
Tracy: I am not authorized to do that and I need.....
I: a printed copy, I know. I will find my copy. Thank you. Can I fax it to you.
Tracy: No, sorry, we need a hard printed copy.
I: What is the address I can mail it to?
Tracy: You can mail it to the address found on the back of your insurance card or on the bottom of your letter.
I: Great, thanks.
Tracy: If there is anything else I can help you with, please let me know.
I: No, thanks you have done enough already.
AND WE WONDER WHAT IS WRONG WITH THIS COUNTRY? All of this to get the insurance company to pay a $680 bill for lap work for a stool sample of all things. Excuse the language, but all of this crap for them to test a bunch of crap!
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3 years ago