When the envelope arrived in my office mail slot — I have a psychotherapy practice in Madison Valley — I felt a flutter of hope. But it soon died.
Instead of a check from a certain insurance company notorious for its reluctance to pay claims, let’s call it Darth Healthcare, what I found folded inside the envelope was a single sheet of paper.
“We received the above claim for [client name],” it said. “Before we can process it, we need information that was missing, invalid or illegible on the claim form you submitted.”
In a little box immediately below, the letter asked me to provide “the following information.” The following space was blank.
We hear a lot about the horrors of a government-run health care system, the supposed inefficiencies and restrictions. But while pundits panic about "death panels" and other hypotheticals, my clients and I are adrift in scary waters, fending off real attacks by private-sector pirates.
And the form I'd just received was a shot across the bows. I’d seen its like before. It was letting me know that a claim I’d sent off so carefully five weeks before by both FAX and the U.S. Mail, with all its i’s dotted and t’s crossed, and with a spare copy of my W-9 attached just in case they’d lost the three I’d already sent them, had failed to be accepted. My claim was in limbo, not rejected but not being processed, either. The closest thing I could find to an explanation was a code, “E8.”
What did “E8” mean? I had a free hour and thought I’d use it trying to find out.
First, I called the number the form letter advised me to call. This led to the usual round of recorded prompts, at which I punched in my tax ID number, my National Provider Identification (NPI) number, and my patient’s ID number and date of birth.
“For claims,” the recording said, “press 3.”
I pressed 3, and after a fairly brief wait I heard the voice of a young man whose accent gave me the impression he was African-American, who very helpfully spoke with me for about 15 minutes. During this talk of course I needed to give him again my tax ID number, my NPI number, my patient’s ID number and date of birth, and the service dates on my outstanding claims.
He said that “E8” meant that my forms were incomplete.
“What’s missing?” I asked. He paused. “Well, um...nothing, as far as I can see.” Pause. “I don’t know why they marked this as incomplete.”
I had heard this kind of thing before. The last time I’d called this insurer had been about a month earlier. That time, I’d been told that my claim had been marked as illegible (I think the code was “E4”), though the staffer on the phone was looking at my claim and could read my writing clearly.
The young man interrupted my reverie by offering to put my claim in for review. This would take up to 15 days, he said, and he gave me a confirmation number that probably had more digits than he had years of living behind him.
We were just about done, I thought, pleasantly surprised to see by the clock that only 20 minutes of earth time had elapsed while my young man and I were in cyberspace together. “Oh,” I said. “Before I go, could you please let me know about a claim that was put up for review about a month ago?” And I rattled off the confirmation number.
He went quiet for a minute or two while I waited. Then he was back. Was I imagining an ominous change in his tone? “One question,” he said. “Is this a medical claim or a behavioral health claim?” “Behavioral health,” I said.
“Well,” he said. “This is not the right number to call for behavioral health claims. This is medical claims.”
“Oh,” I said, impressed by the utter unforeseeability of this twist. “But the other claim we were talking about was also for behavioral health. ”
My young man, who was suddenly not my young man after all, gave me a different phone number, and then transferred my call.
Once again, I had to pass the ritual checkpoints: type in my tax ID number, my NPI number, my patient’s ID number and date of birth. The recorded voice then offered me a series of choices, none of which was “claims.” I listened again. “If you have received a letter from us, press 3,” the voice suggested. I pressed 3.
After a brief wait, a soft-voiced young man with an Indian accent greeted me. After we went through my tax ID number and the other numbers, I thought we were becoming old friends. But it was not to be. Five minutes into our conversation my new young man realized that he was not the person I was supposed to be talking to. He was not in the right department at all.
I admit I took it hard. But I tried not to show my shock, or the fleeting despair I felt at being abandoned so soon. “Will you please tell me which number I should call?” I asked, and was glad to hear that my voice was almost as blandly pleasant as the recording’s.
Another number. Maybe it was the right one, I thought hopefully, because it was not to be found anywhere in the form letter I’d been sent or, as far as I could find, on the company’s website. Maybe this was the secret, inner sanctum claims processing number, the one they gave you if you proved your worthiness by never having given up hope. I dialed. Another ritual entry: tax ID number, NPI number, and the like. “For claims, press 2.” “Please hold.”
I looked at the clock: 11:38. Twenty-eight minutes and counting. I wondered if I would have time to finish this call before my noon appointment. The recording asked me, pleasantly enough, if I would take a survey after my call. “No,” I said, hoping Darth Healthcare would not retaliate by vaporizing my claims.
Eventually, a woman with an eastern European accent answered. This time, I asked her name (Ria) and wrote it down carefully on the sheet of paper I keep in my patient’s file for this kind of information. “I was told this is the right place to call for claims for behavioral health services,” I said. “Is that right?”
Yes! It was. So far, so good. Ria’s and my conversation went on very much like the first conversation I’d had with the young African-American man.
Ria, too, couldn’t say why my claims were being held up. But I did find out what had happened to my June 9 claim review. “The reviewer said that the claim was properly handled,” she said.
“Do you mean it’s been denied?” I asked.
“No ... hmm. I’m not sure why they said it was processed correctly,” Ria said. She was quiet for a minute or two. She came back on. “I think I see the problem,” she said. “They didn’t have your information.”
“What information?” I asked, and heard my voice crack.
“Well, your tax ID number, and your NPI number, and your office address.”
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