One such encounter went like this:
Me: “Hi. I’m calling about my daughter’s ambulance and hospital charges. I haven’t been able to reach my grievance coordinator about the appeal.”
Representative: “I can help you.”
**Me: **(Genuinely excited.) “Great!”
Representative: “Oh, I see your daughter turned 18. I can’t discuss her information with you.”
Me: “I sent a release of information form by mail, fax and email. I also faxed our conservatorship papers.”
Representative: “I’m sorry, it’s not on file. What office did you send it to?”
Me: (I give the information.)
Representative: “That’s the wrong fax number. Let me give you the correct one.”
Me: “I’m not inventing numbers out of the ether. This is the third new fax number I’ve been given. Are the address and email inaccurate too?”
Representative: “I’m sorry, but I can’t discuss your daughter’s claims with you without this information. Can you put her on the phone to give verbal consent?”
**Me: **“I can’t put her on the phone. She’s currently in a treatment center and has no access to a phone, which is why I have a conservatorship to help with her medical care.”
Representative: “I’m sorry, ma’am. There’s nothing I can do without the forms or her verbal consent.”
Me: “Who do you think pays the insurance premium and all her providers? I’m just trying to settle her claims, and I don’t know what we owe without access.”
Representative: “I can only answer general questions.”
Me: “OK. From the bills I’ve received, we’re being charged out-of-network fees for the ambulance, ER, ER doctor and hospital.”
Representative: “Was this out of state?”
**Me: **“Yes.”
Representative: “Hang on, I have to transfer you.”
I was on hold for another 15 minutes, and then got cut off. I called back, was transferred twice and then repeated a version of the above conversation before resuming — with a grievance coordinator!
Grievance coordinator: “The ambulance and ER facility were both out of state and out of network.”
Me: “A treatment center called for an ambulance. I wasn’t given a choice of who responded or where they took her.”
Grievance coordinator: “They used out-of-network providers.”
Me: “They dialed 911. No one stops to ask the closest ambulance what their network status is.”
Grievance coordinator: “They did transfer her to an in-network hospital, but the physicians were not participating providers.”
**Me: **“Under the No Surprises Act, insurance must cover all providers in the case of an emergency, whether they are in network or not — even if out of state.”
(There was a long silence.)
Me: “Are you still there?”
Grievance coordinator: “Yes, ma’am. Once you get the conservatorship papers to us, we can look at those claims. Is there anything else I can help you with?”
Me: “Apparently not.”
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OP, you may be in lawyer territory. Not to sue the insurance company, though it may come to that.
A lot of these companies will give riff raff (you and me) the run around.
But once an attorney enters the picture, they have to get their attorneys involved and typically corporate attorneys aren't cheaper than one you hire. So the incentive to resolve the situation quickly is higher.
At least for a short time. So a short phone call from your attorney to them will often get the attention of the right people.
It's an article in the Huffpost bro, the author isn't here.
There's a reason Allstate is the most frequently sued auto insurance provider. They will give you the run around all day long until you lawyer up and then it's, "Oh! Ha ha! Sowwy! We bunch of dum dums who no can read and no use kumputers good. We no know what happened! Here big check for you go away now."
But for every person who lawyers up, there are probably 20 more who don't. Fuck Allstate.
Can confirm. I will never work directly with insurance on a difficult issue again. My attorney is worth every penny. He's saved me countless hours of time and the endless frustration/desperation that comes with handling insurance agents. He's also saved me a ton of money in the long run (but not the short run!).