For Part 1, click here.
This is the continuation of my attempt at reimbursement for my legal home birth with a Certified Professional Midwife. When we last left the story, I had spoken with James, who told me that he would call as soon there was something to call about. This was on January 17.
1/18/12 ~ I receive notice from my midwife that she has received yet another request for information (that has already been submitted several times). I call Cigna and speak with Jennifer, who tells me that because my midwife is an out-of-network provider, Cigna wants to gather her information to place in my file for future reference. She says she can see they have all that, so my midwife can ignore it. She also tells me that once that information goes into the system, my claim should be approved.
1/19/12 ~ At 7:39am, I receive a call from James. He tells me that my claim has been processed and approved! He says a check will be coming within 7-10 business days and gives me a dollar amount of $1617.03. I am super excited and ask him to repeat that just to be sure. He does and we hang up.
~ Later that day, I call Cigna back to verify what I was told by James. I speak with Karen, who assures me that yes, my claim has been approved and processed. Money will come within 7 -10 business days.
1/25/12 ~ My midwife receives a fax asking her to accept $1500 as a fee instead of her invoiced $2500. I am confused as to why she’s getting this when the claim is processed, so I ask her to wait while I call Cigna. I speak with Lisa, who tells me that NO, my claim has not been finalized or released, but that it should have been. She is making a note, sending it to “escalation”, gives me a reference #5459 and says that the check will be out within twenty-four hours. I will receive a check by February 16.
1/28/12 ~ Speak with Mary Ann (who, according to my notes, started out the conversation not very nice). She says that all three of the previous agents were wrong and that my claim is in external claim division (where they try to negotiate a lower rate). I am getting angrier by the minute and I lost most of my self-control when I ask for a supervisor and she tells me that she is a senior representative and knows what she is talking about. I start out telling her the entire story and end by stating firmly and loudly that I
ANGRY and I will be filing complaints with both the Better Business Bureau and the MO Attorney General. I also request again to speak with a supervisor, finally getting to a voicemail. I did apologize before I hung up and acknowledged that she was simply doing her job, although I also stated that I thought it was her job to keep me from my money.
~ After hanging up with Mary Ann, I immediately go to the Missouri Attorney General’s website, where I am (not) shocked to see eight other complaints filed against Cigna. I file my own complaint, being clear that my issue is not that I don’t have money, but that three separate agents told me I was receiving money and then I was told something completely different. I also say that part of my complaint is that every single time I’ve called I’ve been told something different (except for the three times I was told a check was coming!).
1/31/12 ~ Speak with Betty, ask to be transferred to supervisor (since it has been two days with no return on previous voicemail). I am transferred to Matt, who tells me that what has happened is standard procedure. All claims for out-of-network providers must go through negotiations, but will show in the system as “processed” if the agent isn’t paying close attention. He also tells me that there are two claims still in the system, and I almost lose my cool again. He says that the claim will get paid, it’s only a matter of waiting for the negotiations to end. I am sure to let him know about my complaints, again stressing that my complaint is NOT because I don’t have the money yet, but about the manner the company has gone about it. He says he understands and that he will be watching this to make sure it goes through correctly. I will have the resolution in 15 days.
2/7/12 ~ Speak with Dina, who tells me the claim is still in negotiations.
2/9/12 ~ Receive a call from Cathy, who tells me that the claim has been processed, check # and amount ($1617.03). Is this really happening? Is it over?!!
About a week later, we opened the mailbox….and there it was! Finally!!
So, my advice to anyone attempting reimbursement is to ask every possible question you can think of (and then some) beforehand.
*What information will they need? NPI, Tax ID, Social, Address, Codes, etc.?
*Does your insurance carrier do a “global fee”, meaning they pay for the entire package of services after rendering, or do they want per visit?
*How long do you have to file for reimbursement? Is this dependent on the type of bill it is? For example, our “timely filing” clause was 180 days, but that was for the global bill. If we had been filing a different type of claim, it would have been different.
*Keep records of EVERYTHING. Write EVERYTHING down. Make a folder designated specifically for this, so you have it all in one place.
*Be persistent and firm. Call every day or every other day, if you have to.
*If you don’t understand something, ask. If you do understand, ask anyway. Verify everything you are told.
*Do not hesitate to ask for supervisors.
Good luck!
