Sunday, April 29, 2012

Strange Reimbursement letter from the Insurance Company: Will you be liable if the insurance company doesn't submit your expenses for reimbursement?

I sure can tell you that these insurance companies never cease to amaze me. 

I have discussed this reimbursement issue with you in prior posts.  Depuy/Broadspire has always been cooperative in reimbursing my direct expenses.  Earlier this year, I decided to just send a block of expenses in from Blue Cross to Depuy so that all expenses would be reimbursed.  Strangely, I got the biggest run a round trying to get the Blue Cross people reimbursed for these expenses.  Blue Cross refused to submit all of the remaining $50,000 or so to Broadspire so I decided to do it myself.

I got this utterly stupid shocking note from the office of the CEO telling me the following:
  • "We can not continue to process claims in this manner."  What the heck?  Oh so you want your claims to accrue until you have no chance of getting reimbursed?  A very strange business practice in deed.  In effect, they told me to let the claims be and they would take care of them.

  • "As with any other claim, your providers must submit all of your hip related health care claims to Blue Cross.  The claims will then be processed according to your plan"  Well, I got news for you Blue Cross, I hope you know that many of my claims have been processed directly.  That is, the claims go into Blue cross and then I have the claim refused and sent to Depuy.  They have been doing that for a year.  Now you are finding out how your subrogation plan is really working in your company?

  • "Please contact Broadspire's customer service dept  with any questions regarding disbursement."  Well, I got news for you again, I reviewed all of this with Broadspire prior to attempting to help you get your money back for claims on my behalf.  All you had to do was submit the list of claims to Broadspire and they would have paid them.  What kind of insurance business would turn away the reimbursement of a claim through a subrogated right they had to get that money.  Essentially, what they did was turned away the ability to collect on a $50,000 receivable!  Who would be so stupid?

  • So the final phone conversation went like this:
    • Connie: Are you telling me that you don't want this money?
    • insurance company:  I am telling you that we have a process in place with 3rd party attorneys to collect this money.
    • Connie:  I was told you have collected no money from Broadspire on behalf of your clients
    • Insurance company: That is correct but we have a process in place to do so.
    • Connie:  but I can get that reimbursed now.
    • Insurance company:  Thank you but we don't need your help.
Good God.  This person was the assistant to the CEO of the Blues in my area.  I hope they don't promote him to any other function for the insureds sake!

The issue with this is that, Broadspire is paying all of these claims voluntarily and I think they  have been doing a good job. From my perspective, I don't want to be burdened with some lien in the future if these geniuses at the insurance company can't collect. I am going to send the CEO of the insurance company recapping what went on so that it is clear they are turning down the right to collect to get paid now in exchange for perhaps never getting reimbursed.

Now, if I were an insurance company, I would put a plan in place to subrogate those costs immediately as they are submitted for every case.  Why?   The better question is why not?  Who is to say that they will have enough set aside to honor these payments in the long term.  The $3 Billion is not going to scratch the surface in my mind.  Simple math will tell you that. 

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