How to get past customer service to get a claim paid

jan2000 · 11-10-2009, 05:07 PM

I am having problems getting a claim paid with Great West. This claim is from November 2008. It was a 3 visit procedure (Synvisc injections to his knee) and the first two identical visits were paid last year.

In September 09, I got a bill from the hospital. I thought it had all been paid, as I did have to go through a couple of iterations of sending my previous coverage info to show that it wasn't a pre existing condition (note: he did have the procedure approved by insurance before he ever had it.)

I called 9/11/09, the customer service rep said that all of the info was in the system, that the claim should be paid w/in 10 days. I have called 4 more times, including today (11/10), each time I get the same answer that it should be paid w/in 10 days...I am at my wits end.

The hospital has sent this to collections eventhough I have kept them informed as to what I have been doing and what the insurance company is saying.

I asked to speak to a supervisor and got their voice mail...they are supposed to return my call, but that was an hour ago. Who should I call to get this taken care of once and for all?!

Any help appreciated!!!!

Titchou · 11-10-2009, 05:13 PM

Well, I think an hour is a little too soon to expect a call back. Maybe a day or two at the most. If this insurance is thru an employer, ask the company benefits person what to do next. Or you can always your state insurance commissioner's office.

33itsjustme · 11-11-2009, 01:59 AM

I agree an hour isn't that long... I'd give it a day, two at the most. If you do not hear back then you can call back again, let them know that you are available to hold until a supervisor or a manager is available to speak with you. If you haven't already, ask if they are waiting on any information to process on the claim. If they are not, then it is reasonable at this point, it's been 2 months, to request that the representative explain the delay. Sometimes there are claim backlogs and the claim is just waiting in line. If that is the case they should tell you that. I would also request that the Customer Service Representative contact the provider and let them know that there is a delay in processing the claim. Your premiums pay for the benefits and the companies services, they process your claims and provide customer service.
I work in CS at a health insurance co. Our company works really hard to "serve" our members. If I was in your shoes what I named above is what I would do. Good Luck.

jan2000 · 11-11-2009, 07:42 AM

Update: I did hear back and the claim was finally processed...yea! Just a further bit of info, my husband's company switched providers at the beginning of 09, so I didn't have the clout of his company's HR.

Thanks for the feedback!

Jan