Jess and I got a letter today from our health care provider in relation to the trouble we’re having with them paying a claim. It reads as follows (emphasis mine, portions in brackets (“[" and "]“) removed to protect the innocent):
INFORMATIONAL COPY ONLY. ORIGINAL LETTER ADDRESSES TO: [Laboratory Billing Us]
DEAR BILLING DEPARTMENT:
WE ARE RESPONDING TO YOUR 9/15/2003 INQUIRY ASKING ABOUT OUR PROCESSING OF THE CLAIM FOR SERVICES PROVIDED TO JESSICA ON 06/30/03.
WE REVIEWED ALL THE INFORMATION AVAILABLE AND DETERMINED THAT THE ORIGINAL BENEFIT WAS PROCESSED CORRECTLY. PLEASE REFER TO THE REASON(S) LISTED AT THE BOTTOM OF THIS LETTER. AS A RESULT NO ADDITIONAL BENEFITS ARE PAYABLE.
IF YOU HAVE ANY QUESTIONS OR CONCERNS, PLEASE CALL ONE OF OUR CUSTOMER SERVICE REPRESENTITIVES AT [Phone Number].
SINCERELY,
DEPARTMENT NAME GOES HERE
THIS CLAIM WAS PROCESSED ACCORDING TO THE PATIENT’S BENEFIT PLAN.
First of all, the billing department didn’t ask for a review of the claim, I did. Secondly, it mentions the “reason(s) listed below”, but there aren’t any. Finally, I guess we aren’t important enough to even warrant a proof read of the letter the canned letter they sent because they didn’t even bother to replace “DEPARTMENT NAME GOES HERE” with the actual department name.
So, after all that, we still have no information on why services that they claim should NOT be covered until a deductible is met were covered, in part. We also have no information on WHY they require a deductible when their website clearly states my deductible as being $0 when services are rendered “In-Network”. So, I guess I’ll be calling them again on Monday to ask the exact same questions I asked last time to prompt this response from them.