Overwhelmed Staff?!

Anyone ever get a staff member at a Bariatric Clinic who "pushed off and pushed in" incomplete paperwork to an insurance company?! We were under the impression that the "insurance specialist" KNEW when to submit a claim. However, we got an "insurance specialist" at a Bariatric Clinic who submitted a claim to our Insurance Company, w/o verifying if all the documentation WAS EVEN WHAT THE INSURACNE COMPANY REQUIRED. But in "her mind", she submitted everything that the company required. (This was before I got involved) Common sense: If the claim was denied for incomplete documentation, that means, (HELLO) all the required needs were not met and sent in. If you DO NOT HAVE that, DO NOT SEND IT IN, no?! She can't understand the requirements, or she rushed through it, even the Insuracne company told us it was a half hearted rushed job. But SHE is saying she submitted all the correct documentation. Um..NO, if she didn't have 6 month of Dr Supervised Diet, WHY would she submit?! Why not STOP, think...and call the patient?! I don't get it. Would you submit a half complete thesis if you were told that to do so would cause you to fail your course, and then to pass you'd have to appeal with the Deans office? Is it just ME?!! Do these "insurance specialists" so many Bariatric Centers sale you on, do their best even if they're best is causing their Dr to lose money & patients? The mroe I think about it, the ONLY reason someone would send in half baked paperowrk, would be to get it off their plate. Now that we've been denied, after ASSUMING she had what she needed for submission, we know ALL THE RULES, and are now painfully aware that she DOES NOT. People, if you have the chance to submit the first clam yourself, DO IT. DO NOT trust staff to get it right, or to be genuinely concerned for your case...because if they mess up, it's your life on the line! PS Their answer? "We have 400 patients we can't be expected to understand their policies".... Um, there aren't even 400 insurance carriers they deal with. This is the type of response I get. ?!?!?!??!?!?!?!

I know that you are frustrated...it can be overwhleming for both parties...believe me I know. You office can file with your insurance again as courtesy review. Not all insurance companies offer this but most do. If you have your 6 month diet then get it to them and ask them to re-send. This will save you an appeal. Hang in there....

Becasue of this womans total incompetance, and/or desire to ru**** off her plate, my DH is now having to delve into the appeals process now. She somehow thought it was perfectly OK to send in HALF BAKED paperwork...?!?!?! YES YOU, DR ENOCHS OFFICE IN NC. Your staff is complaining that they need more staff. And another thing, I've never heard of one person having so many personal issues to excuse her from utter incompetance on the job. Is that MY problem? Why yes, it is now!