Mumbo-Jumbo
“Provider notice: Authorization is required for this service and no active authorization is on file. Important member information about this denial: Please refer to the ‘benefit limitations and exclusions and/or coverage limitation’ provisions as described in your summary plan description or plan document.”
Versus:
“A claim for services you received has been submitted to Value Options on behalf of MVP. This explanation of benefits is being provided to help you understand the amount charged by your provider and the amount of benefits paid by Value Options on behalf of MVP. It also includes any Copayment, Coinsurance, Deductible and any Non-Covered Charges for which you are responsible. The amount shown above may include amounts that you paid to your provider at the time of service. If you received covered services from a participating provider, that provider has agreed to accept the Allowed Amount, minus any Copayment, Coinsurance and Deductible, as payment in full. If you receive services from a non-participating provider you may also be responsible for the difference between the Billed Charges and the Allowed Amount.”
MAKE SENSE A’ THAT, DEAR READER!
All in the same letter!
(“MVP” is my health-insurance.)
I have a college-degree, earned after cogitating mountains of drivel.
It sounds to me like that first quote is my health-insurance denying coverage.
The second quote talks like my claim will be paid.
As usual I hafta call “the provider” to see what gives.
The provider is “Boike Counseling” (“Boy-key”), and the “psychotherapist“ is Judith Taylor, LCS.
It was suggested I seek counseling after my wife died. I was devastated back then, not much now. That was over three years ago. I wasn’t “referred.”
All of this is interesting since I’ve already seen Judith Taylor 8-10 previous times. And this is the first time I received a letter like this.
My health-insurance also sent previous notifications her claim was paid.
I may have to also call my health-insurance. It wouldn’t be the first time. Not too long ago I got a similar letter saying my health-insurance wouldn’t pay the claim because the service wasn’t “specified.”
That is, “it wasn’t coded,” I was told.
When I ran all this by my health-insurance I was told to not worry. It wasn’t my problem — they would take care of it.
So why the letter? I wouldn’t be surprised to get the same response from Boike.
As if a stroke-survivor can easily parry phonecalls. I usually hafta tell the other party I had a stroke, and may not make sense, or lock up.
At which point some get angry!
What is it with these guys they feel they occasionally hafta jerk your chain?
Weeping and wailing and gnashing of teeth caused by legal mumbo-jumbo, all so the bloated fatcats can buy their Mercedes.
• My beloved wife of over 44 years died of cancer April 17th, 2012. I miss her dearly.
• I had a stroke October 26th, 1993, and it slightly compromised my speech. (Difficulty finding and putting words together.)
Versus:
“A claim for services you received has been submitted to Value Options on behalf of MVP. This explanation of benefits is being provided to help you understand the amount charged by your provider and the amount of benefits paid by Value Options on behalf of MVP. It also includes any Copayment, Coinsurance, Deductible and any Non-Covered Charges for which you are responsible. The amount shown above may include amounts that you paid to your provider at the time of service. If you received covered services from a participating provider, that provider has agreed to accept the Allowed Amount, minus any Copayment, Coinsurance and Deductible, as payment in full. If you receive services from a non-participating provider you may also be responsible for the difference between the Billed Charges and the Allowed Amount.”
MAKE SENSE A’ THAT, DEAR READER!
All in the same letter!
(“MVP” is my health-insurance.)
I have a college-degree, earned after cogitating mountains of drivel.
It sounds to me like that first quote is my health-insurance denying coverage.
The second quote talks like my claim will be paid.
As usual I hafta call “the provider” to see what gives.
The provider is “Boike Counseling” (“Boy-key”), and the “psychotherapist“ is Judith Taylor, LCS.
It was suggested I seek counseling after my wife died. I was devastated back then, not much now. That was over three years ago. I wasn’t “referred.”
All of this is interesting since I’ve already seen Judith Taylor 8-10 previous times. And this is the first time I received a letter like this.
My health-insurance also sent previous notifications her claim was paid.
I may have to also call my health-insurance. It wouldn’t be the first time. Not too long ago I got a similar letter saying my health-insurance wouldn’t pay the claim because the service wasn’t “specified.”
That is, “it wasn’t coded,” I was told.
When I ran all this by my health-insurance I was told to not worry. It wasn’t my problem — they would take care of it.
So why the letter? I wouldn’t be surprised to get the same response from Boike.
As if a stroke-survivor can easily parry phonecalls. I usually hafta tell the other party I had a stroke, and may not make sense, or lock up.
At which point some get angry!
What is it with these guys they feel they occasionally hafta jerk your chain?
Weeping and wailing and gnashing of teeth caused by legal mumbo-jumbo, all so the bloated fatcats can buy their Mercedes.
• My beloved wife of over 44 years died of cancer April 17th, 2012. I miss her dearly.
• I had a stroke October 26th, 1993, and it slightly compromised my speech. (Difficulty finding and putting words together.)
posted by BobbaLew at 12:43 PM
0 Comments:
Post a Comment
<< Home