As I have gotten older I am pretty sure that my thought processes have slipped somewhat. Maybe I am just getting grouchy. But it seems to me that the people in this world are often lacking in the common sense department; I think more so than they once did. At least I am noticing it more.
As one example, I called the customer service department at my phone company the other day to ask what was the highest speed internet service they had available at my location. I live in a rural area and although they have been upgrading their equipment over the years they still have not been able to provide me a connection speed of more than 1.5 mbps. I told the girl at customer service what I wanted and gave her my name and phone number. She said, "I need the last four digits of your social security number."
I gave them to her. She said, "We don't seem to have your social security number in our computer. What is your full social security number?"
"I am just asking you a question about speed of internet service. What does my social security number have to do with that?"
"We can't give you service unless we have your social security number to verify your identity. Since we don't have your social security number I can't verify that those last four digits you gave me are correct, so I need you to give me your full social security number so I can verify your identity by comparing the last four digits."
They are my phone company and, it seems to me, have been giving me service for years without my social security number but now they can't even answer a question about their service without it.
So I repeated my request, this time enclosing an SSAE. In a week or so I got the information I requested. It was a small pamplet that cost the same amount in postage as the letter they had sent me before requesting the SSAE.
She got a letter from Medicare returning the claim form and saying that the signature did not match their records so could the doctor please initial his signature on the form to verify it so that they could pay the claim. He did so and she returned it to Medicare. They returned the form again, this time requesting that he initial his initials so that they could be sure he had originally initialled his signature. She said after he initialed his initials they then paid the claim.
I tried to complain about this to my state consumer protection agency but they said there was no law against this practice.
It would be interesting to determine if Anthem has a corporate culture of nickle and dimeing those they insure or providers of medical services that they pay. I have heard that this is a common practice with a number of large corporations. I think it is something that is often instituted by young business school graduates in today's world.
If the company is smart, the way it is supposed to work is you overcharge or underpay those you do business with by small amounts at random and claim it is an error and correct it if they complain too much, which the majority won't, so that no one realizes that you are doing anything other than making ordinary bookkeeping errors. Some of these young guys in these companies are not smart enough though to realize when they should admit an error and make a correction. When this happens it is possible to expose corporate corruption by victims comparing experiences. I don't know if this is the case with Anthem but my experience raises the possibility.
She said they were grateful for my support and could she then put me down for a monthly contribution?
I said, "What part of 'don't respond to telephone solicitations' did you not understand?"
She said, "I understand you sir. So, if you cannot afford a monthly contribution can I just put you down for a one time contribution of fifty dollars?"
I said, "No!"
She said, "Well could you afford twenty-five dollars then?"
I hung up.
Once a year I give to a number of charities as I can afford and as I desire to do so. Sometimes I think they use all the money I give them to hire telephone solicitors to harass me. So I am paying for my own harassment. I guess I am the stupid one in this case.
I said, "Well, ordinarily I could. But I have been getting so many of these calls lately and people have been sending me so much extra cash that I have filled the back unused bedroom with it and the cash is falling out into the hall so I can't get the door closed. So, at this time, I am afraid I just can't use any more extra cash."
I did this for a couple of years and then I got Medicare Part D drug insurance from a Caremark company called Super Script. They said I could save money on my drugs if I got them filled by mail order from their mail order drug company instead of at my local pharmacy. So I had my prescription transferred to Caremark. They informed me that Super Script would not pay for 1000 mg. pills so they could not fill the prescription but they would send me a one month supply to be sure I did not run out. They did so and billed me $165.00 for the one month supply for which I had been paying $4.00.
I called their customer service and objected and said I did not want $15.00 worth of pills for $165.00. They said that since they had already shipped them I could not return them and I owed them $165.00. They said 1000 mg. pills were much more expensive than 500 mg. pills and since the doctor wanted me to take 1000 mg. they could not fill the prescription with two 500 mg. pills.
The purpose of the colonoscopy, I was told, was to find any evidence of cancer in the colon and to remove any precancerous polyps or growths found.
After I got the colonoscopy, I found that I would have to pay about $300 in various bills. When I called Medicare to find out why I was being charged $300 for what, I was told, would be a free procedure, they explained.
The upshot was that nothing I had done as a screening colonoscopy was considered by Medicare to be a screening colonoscopy and therefore nothing was eligible for the 100% payment.
May 27, 2016 - called 1-800-633-4227 - The Medicare customer service.
Asked for answers about preventative services. I talked to Sueallen.
I asked her if it was true, as my doctor had told me that Medicare would pay 100% of the cost of my colonoscopy. She confirmed that. She said I would not have to pay any coinsurance, copayment or part B deductible.
I then asked her if Medicare would then cover the initial visit to the gastroenterologist to set up the procedure and the following surgery center and the procedure even if a polyp was found and the followup visit to the doctor and she said "yes" in each case.
I then informed her that she was wrong because in the circumstances I described that they would only pay for 80%. She then backtracked and said that she had not said Medicare would pay 100% in all those cases but she had meant that Medicare would cover all that at the regular 80% level with me responsible for my copayment and deductible.
She said that if I had informed her in advance that I had already had the procedure, she could have answered me differently.
She insisted though that Medicare would pay 100% of the cost of a screening colonoscopy. She read me a definition that said a screening colonoscopy included looking for precancerous conditions and removing suspicious growths such as polyps.
She referred me to:
I found this definition of a screening colonoscopy:
The definition of a “screening colonoscopy” per CMS guidelines is as follows: “A colonoscopy being performed on a patient who does not have any signs or symptoms in the lower GI anatomy PRIOR to the scheduled test.
Send a written request to the company that handles claims for Medicare (their address is listed in the "Appeals Information" section of the MSN.) Your request must include:
Your name and Medicare number.
The specific item(s) and/or service(s) for which you're requesting a redetermination and the specific date(s) of service. send copy of MSN
An explanation of why you don't agree with the initial determination.
Your signature. If you've appointed a representative, include the name and signature of your representative.
and Electronic Medical Records - They should be in the cloud but aren't