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A couple of years ago I thought my health insurance company had made an "honest" error in my health insurance billing.
The initial call indicated they would fix the problem, but a follow-up call indicated that they were running a large scale fraud operation and they wanted me to appeal through their channels rather than legal channels.
The Attorney General for the state of Washington was willing to take the fraud case, but I had poor notes and had to write down the conversations from memory. I didn't expect to file a fraud case.
Their suggestion was to in the future tape the phone conversations.
In some states, you don't need tell the other party that they are being recorded, BUT in a majority of states both parties must be notified that the conversation is being taped.
Yeah, I am calling the insurance company AGAIN, this time I am NOT assuming it was an HONEST ERROR.
By the way, the large scale fraud operation was simple. For some appointments, they used an OUT-OF-NETWORK address for the medical clinic.
EVEN THOUGH it was the same doctor, in the same room that I get ALL my medical care, except for emergencies. It was suppose to be a FREE PHYSICAL as specified on PAGE 38 of the insurance contract. They simply used the out-of-network address and it automatically generated a 51 dollar charge for the doctors visit and most of friends just paid it!!!
President Trump signed the NO SURPRISES ACT in 2020, that got rid of the practice by requiring the medical facility to tell it was a OUT OF NETWORK visit beforehand and the insurance had to pay for a network visit unless this was done at the beginning of the visit.
Anyway, it is a handy way to use an IPHONE and IPAD to document phone calls with insurance companies and others.
Just don't forget to tell them your recording the call!!
That is decent advice, but I go one better. I do not discuss anything that might involve future litigation over the phone. I write a snail mail letter instead and keep a copy. If I see a strong potential for dispute, I do a CC to a third party.
Show up with a strong case and strong documentation and most times you quickly end up on top.
They are on their best behavior when you tell them the phone call is being recorded!!
What a circus.
My prescription was turned down by a company that had NO BUSINESS relationship with me. Instead of saying this person is not our customer, they just turned down the prescription.
The pharmacist said it didn't matter to whom the prescription approval was sent to, and I could just fill the prescription by paying cash!!!!!
REALLY...how easily we accept corporate corruption and incompetence these days.
Is there some reason you couldn't simply have the Dr's office re-submit the claim with the proper address? Our doctor's staff will go way out of their way to get the insurance company to cover things that are denied. In the past I argued my case on the phone until I was blue in the face, but once I talked to the Dr's office, they quickly spotted the error that caused the initial denial, and it was quickly approved by the insurance after the error was pointed out. Incidentally, I needed the device that was denied immediately and paid cash out of pocket for it, and then was re-imbursed by the insurance as soon as my appeal was approved. Just save your receipts!
The article OP posted does not actually list the states that require 2 party consent. There are 11 states that require both parties to agree: California, Delaware, Florida, Illinois, Maryland, Massachusetts, Montana, Nevada, New Hampshire, Pennsylvania, and Washington. All others do not have a 2-party consent requirement.
Also, the article only addressed Iphones. Apps on devices with Android 9 and earlier should still be able to record phone calls without bumping into Google’s latest restrictions. But apps on phones with Android 10 or higher that try to use the accessibility service may run afoul of Google’s new policy.
Is there some reason you couldn't simply have the Dr's office re-submit the claim with the proper address? Our doctor's staff will go way out of their way to get the insurance company to cover things that are denied. In the past I argued my case on the phone until I was blue in the face, but once I talked to the Dr's office, they quickly spotted the error that caused the initial denial, and it was quickly approved by the insurance after the error was pointed out. Incidentally, I needed the device that was denied immediately and paid cash out of pocket for it, and then was re-imbursed by the insurance as soon as my appeal was approved. Just save your receipts!
It was an emergency. Couldn't contact the doctor.
I still don't know the error.
Simply put. The numbers matched, but the prescription went to the WRONG insurance company. Actually, the state of Washington Medicaid program.
They denied my prescription, instead of saying that I was NOT a Medicaid client and the prescription was sent to them by mistake.
I did file a complaint with the State of Washington Insurance Commissioner this afternoon and they will file a complaint against the state of Washington!!!
The Insurance Commissioner office was concerned since it could easily result in a person dying due to clerical error.
There was a recent article where an insurance company had ONE insurance company doctor DENY 600,000 claims and prescriptions in one year. Do the math on the number of claims denied by per minute worked.
The policy was that YOU as the client would file an appeal or pay cash for the treatment or prescription, if you didn't die before that time, and they would allow the claim.
They were transferring the cost to you, in spite of your insurance.
This is what I thought I was dealing with when I started this journey.
I take notes during the conversation. The notes would be admissible in judicial proceedings. However, for those that function in the gray zone, one could use a cell phone in speaker mode and place a recorder nearby to fill in any gaps that you may have missed in your note-taking. Alternatively, you could place the call on speaker and have a family member sitting by to take notes.
The article OP posted does not actually list the states that require 2 party consent. There are 11 states that require both parties to agree: California, Delaware, Florida, Illinois, Maryland, Massachusetts, Montana, Nevada, New Hampshire, Pennsylvania, and Washington. All others do not have a 2-party consent requirement.
Also, the article only addressed Iphones. Apps on devices with Android 9 and earlier should still be able to record phone calls without bumping into Google’s latest restrictions. But apps on phones with Android 10 or higher that try to use the accessibility service may run afoul of Google’s new policy.
I don't think there is downside dealing with corporations to tell them you are recording the call. Otherwise, I suspect if you got to legal proceedings it might be thrown out of court, but I am not a lawyer.
The Iphone on speaker and my IPAD on Voice Recording worked perfectly.
Body shop working on my truck had correspondences via email with USAA, and when they would change thier story, the body shop would respond with the original email as documentation as to what the insurance company originally agreed to. When they say "This phone call may be recorded for training purposes", don't think that you, the customer, will be able to obtain that recording, it is thier property.......document, document, document.
Yesterday my husband spent 2 hours on phone trying to get estimate for charges he'd pay for a colonoscopy, he's on Medicare with a supplement plan. I told him to request a written estimate because they won't stand by anything he "misunderstood" on a phone call. He's still trying to find out that $ amount.
My last colonoscopy had a $1k charge added from the anesthesiologist that I was given no heads up about when I asked about my share of cost well in advance of scheduling, pre-Medicare age. Should be illegal not to give everyone a full explanation of fees they will be charged based on their insurance.
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