STOP THE PRESSES!

I have big new!

HUGE news!

My fight with The Idiots is over!

And!?

Believe it or not, after over two years from the original date of service, I have received a full refund for roughly $1200!

As you know, I’ve been fighting with Anthem Blue Cross (through Medi-Cal) and St. Mark’s hospital for a very long time.  I’ve been given runaround, shoved aside, and ignored.  After several instances of getting my hopes up because I talked to someone who claimed they could help me then refused to return any phone calls I was beginning to believe I would be dealing with this stupid, ridiculous claim for the rest of eternity.  In short, I have been calling them at least every two weeks (usually more often) to make sure they are actually still working on my case.

I haven’t posted about it much the last 5 months or so aside from the “Yes, I’m still dealing with this crap,” comments because it makes me so angry I can hardly speak let alone form complete sentences.  There have been some appalling things that went on and I have it all written down for my records but I’ll spare you most of the details until the more recent past.

After getting so fed up with the back and forth and nothing ever getting accomplished I called hospital administration, made them fully aware of how unhappy I was with the (lack of) service I had been receiving, and demanded they do something about it.  My case was sent to the woman, Ms. S, in charge of escalated accounts.  She did her best and worked really hard for me.

Even with her help the claim was still sent back and forth several more times because ABC kept telling them to change things then rejecting the claim anyway saying something else was wrong.  I never dreamed I would be someone to yell at some random person over the phone but in this case I have become one of those people.  They would tell Ms. S one thing to change then tell me something else that needed to be changed.  And it was never the same two times in a row and every thing we did was wrong.  It was like they looked at it until they found a mistake, then sent it right back without looking at the rest.

One day I called to check on the submission seeing as how it had finally been 45 days (yes, they take the full 45 days almost every single time they review anything!) again and it had been rejected once again.  Big surprise.  I went over the history of codes that had been submitted with her and she put me on hold so she could “ask why it was denied this time.”  It was a code that had been several times before and each time had been rejected.  I asked her where a list of correct codes might be found and she told me the provider should have the list.  I told the woman on the phone to please have my claim looked over COMPLETELY before it was returned to Billing.  I asked them to mark out ANYTHING that could POSSIBLY be an issue so it could all be corrected.  She seemed personally offended by this request and was rude about it saying I wasn’t listening to her.  I repeated back everything she’d just said to me and said, “So actually, I don’t think you listening to ME!” and repeated my request for a complete evaluation of my claim submission.  She was still snooty about it and eventually I couldn’t take it any more and said thanks for nothing.

I called Ms. S to tell her what I’d been told and what I’d asked about and she told me she couldn’t believe the runaround she’d been getting and had never seen a case so difficult to resolve.  That’s reassuring, isn’t it?  She said they’ve corrected or changed everything they’ve been told and she was at a loss.  She was having her Medi-Cal billing lead personally meet with ABC to go over the whole thing and see if they could get it fixed once and for all.  She also told me her billing lead suspected they were stalling because the state of CA is very low on funds and are trying to find ways to put it off.  From the way I was just treated and the way the lady I’d just talked to had to “go check” why my claim had been denied (hadn’t happened before) I got the feeling it was probably true, but who knows.

I called back ABC, got a new person, M, and immediately asked for her supervisor.  She asked what the problem was and I told her.  She pulled up my claim again and looked the whole thing over for me right there.  I told her what code the other lady I’d talked to just a while before had told me was wrong and this new lady told me that code was fine and she didn’t know why the other lady was so rude about it.  In looking it over, though, M found a different code that was wrong.  I sort of rolled my eyes because I’d heard it before until she told me why it was wrong.  She explained that since it was an out-of-state provider it needed to be a “Z” code instead of whatever was currently there.

Then!

Get this!

She said, “Do you have a pen?  Let me GIVE YOU THAT CODE!” (emphases added by me)

I was like, “Shut up!  You’re actually helping me?  You’re actually giving me the information I need!?”  Needless to say I couldn’t believe it.  I told her she was an angel and asked for her name in case it all worked out.  She assured me it would and said with that code on the corrected claim I “shouldn’t have any problems.”  Bless that woman!

I immediately called up Ms. S and told her what I’d just found out.  She said she’d talk to her billing lead, double check it, and get it resubmitted.  I had a sliver of hope but still figured it was a long shot after all the crap I’ve been through.

Several weeks went by and I called ABC on Monday.  I was told they had paid the claim!  I said, “Really!?” and the lady said, “Yeah, we paid $126.82.”  I said, “Wait, that’s all?  What about the rest?”  The lady I talked to said that was all the state of CA would pay because it was out of state, blah, blah, blah, whatever.  I reminded her Peanut was fully covered at the time of treatment but she wouldn’t give my any more info and said I had to take it up with the hospital.  Then, she gave me the obligatory, “Is there anything else I can help you with?” to which I replied, “Yeah, the rest of my money,” before hanging up.  See what kind of a phone jerk this has turned me into!?

I called up Ms. S to see what the deal was.  She told me they’d just received notice it had been paid and then told me how my refund would be given.  I asked her if the $126.82 was really all they were going to pay and she said yes and I was like, “So basically I’m just out $1100.”  To my utter shock she told me, “Oh, no!  We have discounts and contracts and stuff so you get all of it back!”

What’s that!?  I get all of it back!?  No. Freaking. Way.

I couldn’t believe it and told Ms. S so.  She assured me it was true and I told her how incredibly grateful I was for all her work.  I also told her I hope I never have to talk to her again, and that I meant it in the nicest way possible.  She laughed and said I’d probably still have to one more time when everything was processed.  She said it may take a little time and I told her I didn’t care, as long as it was coming.

As soon as I hung up I texted ODD and he couldn’t believe it either.  I didn’t dare blog about it because the money wasn’t back in our account yet and I didn’t want to jinx it but I was totally hoping it really, truly worked out.

I didn’t expect to see the money for at least another month but to my surprise the refund check came in the mail yesterday afternoon!  I showed it to ODD and anyone else who happened to come by.

After such a long, hard, obnoxious fight, I am VICTORIOUS!

I cannot express how much the stress of it constantly nagging in the back of my brain was.  I feel like a brand new woman!  I don’t know quite what to do with myself and frankly, after opening up the check I was speechless for a long time.  It seems almost too good to be true, but the money is in our account even now!

After earning every single penny I’m going to take some of that hard-earned money and do something fun with it.  I’m not sure what just yet, but something so I can celebrate.  Maybe a spa day, or a new bike, or a new outfit.  I don’t know, but being able to completely wash my hands of this is certainly cause of celebration!