Remember when I posted yesterday about how I was happy that the Ins. co. finally received my file? Remember that?:huh2:

O.K. here it goes

I called them today (fyi I call everyday) to see the status. I was told by the rep that the medical review board needed more information and that a letter was sent today stating such.

me: Missing what?

she: three years of medical history

me: I don't have 3 years. There were several years that I didn't see a dr.

she: you didn't?

me: no. I have been a bc bs customer for 10 years check my claims records. no dr. claims for 05, 06

she: you have to have medical recorded weights

me: no, my policy allows the use of photos as documentation in lieu of records :embaressed_smile:

she: no it doesn't

me: I am a type a personality when it comes to taking care of business. Trust me on this

she: no that is not the policy

me: I will hold while you confer with a peer or your supervisor:mad:

she: hold on. OK I talked with my sup and she is looking into it can i call u back

me: yup:ack2:

Now 10 minutes later i get a call

she: I did some research and I see what you are saying

me: I told ya:smash:

she: but we need a letter from your dr. explaining why they sent photos

me: what? they did that already. i'm gonna give them a call

so I peaced her out and called my dr office and they informed me that this is the second concern that they have gotten in a week. Someone in the mail room is opening the mail taking out the photos and only sending the claim to medical review. I need to send photos again and we will resubmit:mad5:

MY MOMMA DIDN'T RAISE NO PUNK SNITCHES

I called ins. back asked for a specialist for my contract group and explained everything including the fact that my photos were somewhere unauthorized with my name, b date, and all on the back

FURTHERMORE

I am going to check and see if this violates HIPPA I also have the complaints number written down but I would like to settle this before we get to that point Besides I should not have to resubmit after this long process

new she: I am so sorry, I am going to see what the problem is and i will call u tomorrow

15 min later I get a call:rolleyes2:

new she: my supervisor and i searched for your info. we found one pic. I promise we are going to find the other and i will give u a call tomorrow.

me: how long will i have to wait on a decision?

she: not even a week

me: blowing smoke off gun, twirl back in holsters and walk off

a hot mess

Once again, pray for your girl

That definitely is a HIPPA violation. When you start mentioning news papers, tv stations and lawsuits, I guarantee you will get someone to notice! If someone in their "mailroom" is doing this to you, imagine what they are doing for people needing breast reconstruction or has to send nude photos in for medical purposes. Someone in that company needs to be held accountable. Good luck to you!

Okay..I'm scared of you...LOL. I can't belive someone is taking photos. I'm sure you will get your approval before the end of the week because they know you are not playing. Good Luck

Girl, I need you to come deal with my insurance company! You go sista!

I want to be like you when I grow up! LOL! I hope your approval comes soon!

I love you, girl! That same firery spirit is the same spirit that make you very sucessful once you get the band. You won't give up!

On the flip side, please follow-up the HIPPA violation (cause that's what that is when your pictures are missing with your personal info) with a written complaint to the insurance company. Keep it professional and factual. If your insurance is through your work, cc a copy to the benefits person and your union rep if you have one. Meanwhile, keep your local TV station on speed dial :biggrin:I was once successful in persuading my company to cancel a provider due to repeated billing problems. It was a big contract. Insurance companies think twice when they think they will lose business and employers think twice if employees might start leaving due to jacked up benefits problems. Keep copies of everything submitted to the insurance company. Although your physician keeps copies, you should have your own personal copies. Document every call and the name of each person you speak to.

All too often, folk see a person of color and decide to mess over us because they figure we won't follow through! Help dispel that myth! Go girl! :frown:

Good for you. They thought they were dealing w/ the average person.

Better ask somebody

Thanks ya'll for rallying behind me :obama fist bump::cool2:

Tammigirl you are on point! I would not want to get into a legal tango with you.:smile:

It's a shame that you have to get stressed out for nonsense.

Update:

This morning my phone rang

me: hello

new she: Hey April I just got to work but I wanted to update you

me: Yeah , this thing has had me worried. see i am a private person and it disturbs me that my information is somewhere willy nilly

new she: I know it bothered me last night that's why i called you first thing this morning to let you know that we are working on it

me: yeah well i am still looking into hippa vioalations someone needs to be held accountable

she: I promise you that the person over the mailroom is taking this very seriously

me: in the mean time what can we do to expedite this? mailing will take another 10 days and I have already spent 7 months jumping through bc bs hoops so 10 days is a life time.

she: i understand, you could always bring a copy of the missing photos up here

me (thinking)-what , that's an option , oh hell yeah

me aloud: absolutely

she: Bring it in the morning and put it to the attention of the medical review board: i will call them and tell them it is urgent

me: I will do it 8 am

she: talk to ya later

me:too mentally exhausted to do or say anything else

pray for your girl and that's on the real

I'm praying for you April! :biggrin2:

I hope you got a chance to drop off the photo yesterday. Maybe the guy in the mailroom thought you were a real cutie:wub:! Good Luck!

April:

What a saga. I will definitely keep you in my prayers.

You are a real fighter, more people need to stand their ground, as you have. Big business think they can just step on the little man, with no consequences. Definitely, continue to look at the possibility of a HIPPA violation.

It took me about 3 weeks, to get my approval and but during that time my surgeon was no longer in network for United Health Care. So the surgery will cost much more than I had originally planned. :wub:

Edited July 18, 200818 yr by TravelLady48