Thursday, June 13, 2013

Best Health Insurance Ever

I have health insurance through the University - JD and Nora are my dependents.  Besides a few sinus infections, we aren't exactly 'frequent flyers' for our health plan, but with my pregnancy, Nora's birth and subsequent hip dysplasia and a few other ancillary things, there has been a slight uptick in the number of EOB's (Explanation of Benefits) that our household receives.  I guess our insurance company has been thrown by our increased usage of the plan when I received these two forms in the mail (in separate envelopes) for a visit by JD to a minor medical establishment for a sinus infection.  These are fantastic examples of how incredibly intelligent our insurance company is:

Form #1

Insured: Kathryn Graffam
Claimant: James Graffam
Date of Service: 5/14/13
Provider of Service: XXXX

Dear Insured:

XXXX Administration, servicing your student insurance claims, has received charges for the above-referenced services.  Prior to processing these charges, additional information is needed:

Do you have health insurance prior to the date of service? (   )  Yes  (   )  No

Yes - we have been your customers for over two years without interruption.

If the answer is yes, please provide a copy of the Certificate of Credible Coverage from your prior carrier which shows the last 18 months of coverage.

Why don't you issue the certificate to yourself?


Signature of Insured: ____________  Date:____________

Important: Processing and evaluation of your charges will continue after we receive the requested information.

Yet, there is no address, return envelope, phone number or hangman puzzle in which to instruct us on how to return the above information.  Genius, right?

Form #2

Insured: Kathryn Graffam
Claimant: James Graffam
Date of Service: 5/14/13
Provider of Service: XXXX


Dear James Graffam

We have received a claim for the above referenced service.  In order to fully evaluate this claim, additional information is needed.  Please provide our office with the following information:

1. Date symptoms first appeared:

His nose started running the night before?

Date medical treatment was sought:

You already know this - it's in the letterhead

2. Was medication prescribed for this condition?

Yes - you already reimbursed us for it.

3. List names and addresses of all physicians treating you for this condition:

You mean the random guy in the white coat who signed off on the CNA's recommendation?  His name and address is in your letterhead as well.

Your Signature______________  Date___________________

Processing of this claim will continue after we received the requested information.  If you have any questions, please contact our Customer Service Department.

No contact information is given.

Sincerely,

Claims Analyst

Enclosure (there is no enclosure)

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