Insurance Rant #99887789999

I'd just like to preface this little rant with a disclaimer: I love most of my work at Hahn and Nelson Family Medicine. However, it seems to be the work of our insurers to suck every little piece of joy out of life that they can. Once in awhile, though, I'll talk to someone who seems to really care. That happened today, after almost an hour speaking to other not-so-caring sheeple.
So one of our patients was told that she had to pay an out-of-network deductible because Aetna told her that the physician she saw was not an Aetna participant. Well, we are, and have been since at least July 15. Of course, this is after months and months of filling out forms and sending in duplicates of duplicates of licenses, etc. for the 12 or so insurance companies we wanted to cover. Don't even get me started on the incredible inefficiencies of the credentialing process (like, why isn't there ONE form, ONE set of standards, to credential physicians?)
So I called Aetna this morning... first thing on my to do list.
8:30 Called Provider Services and made my way through the maze of what number to press, inserted my Tax ID, etc. etc. and got someone on the line who said they couldn't help me because my providers were not linked correctly. We are credentialed, yes, considered participating, yes, but we're not linked correctly to our "service area." What does that mean? My head is just starting to spin. The trip to insurance world has begun. OK, so what number do I call? Got it.
8:45 Called the number I was given, which turns out to be claims, typed in the correct numbers for our tax ID (is there any way to put that on speed dial?) and my patient's ID number, blah blah blah. Got "Jen" on the line who looked up the claim and said that the claim had been processed under an incorrect Tax ID. I replied that that's strange, because the correct tax ID is on my Explanation of Benefits that came back from the claim. She replied that it must be a problem with my biller (yeah, right, let's pass the buck! quickly!). I sighed (deeply) and agreed to call Office Ally to get them to check things out.
8:55 Called Office Ally. They are so  nice to work with... someone picked up the phone immediately -- I only had to press one number on my phone's keypad. Nobody even asked me for an ID number. The representative assured me that the claim contained the correct Tax ID. I asked him if there was anything else that might've caused this to happen, but he was mystified. But he did ask me to call back if there were any other issues. OK, I called them, now back to Aetna.
9:00 Called Aetna back. After having to type in the patient's ID, Date of Service, etc. again, I had to listen to the claim details before pressing "0" to get a representative. It's now 9:10 because I accidentally asked for a fax of the claim to be sent.... duh. But that kind of stuff happens when you're in the altered universe that is the Insurance phone call.
9:10 OK now I have a very competent person on the phone, Sonya. She has the claim information already that I've typed in, but asks a few identifying questions. She tells me that the Tax ID number is fine. It's ours and she doesn't know why both the patient and myself have been told that it was incorrect. But she also verifies that the patient was billed for an out-of-network provider when she shouldn't have been, and gives me a resubmittal tracking number. I'm still concerned about why both the patient and myself were told about the incorrect Tax ID number, and ask to speak to the representative that told me about it. She tries to get my friend Jen on the phone but she's busy. I leave Sonya with my phone number and email address because I'd really like to know why it is that Jen was seeing something completely different from Sonya. Sonya is now my new best friend. Sonya gets busy trying to investigate the mystery herself. She's very thorough, and finds the provider that Jen said the claim was mixed up with but cannot figure out why someone thought it was linked to this claim. Now it's 9:33 and I've been on the phone for an hour. I have a stack of payables and checks on my desk along with some other more fun projects...
9:42 So I called the patient to just kind of wrap things up. She had originally gotten an email about the claim so she's sending that to me. I don't want to become obsessed with this. Blogging about it really helps. Not only will it help me journal my way through this learning process, it also helps me blow off steam!

Update: Sonya called back to tell me that Jen was, for some inexplicable reason, looking at two claims from JUNE. JUNE. We weren't even open yet. Hmmmmm. Hey, I don't know want to hear anything from people who claim the *government* can't run healthcare when this kind of stuff is happening in the private healthcare industry where people are paying dearly for their coverage. Of course, let's see what happens next week when we start filing our Medicare claims! Stay tuned....