Question:
Is it common practice to have your claim sent to a 'Superviser'?

I talked to the Insurance Company and I got that same gal again. She was nice this time. But first she told me that she hasn't heard anything about my claim, then she said that she remembers that on May 30th, my letter and med. records were sent to her superviser for approval. Is this Normal practice? Has this happened to any of you? Also.... Yesterday, I received a letter from the Insurance Co. and they were asking for current status information... (Are there any more Ins Co. we go through, do I work, who are the dependents, etc). They said on the letter that it was just to update their info. But in big bold letters, (and it was high-lighted), that further claims and adjustments will not be granted and/or paid until they receive this back, no later than next Friday. Pretty convenient this comes NOW, as I am seeking WLS. We do usually get these letters each year, but not until the end of August. So it is early this year. What do you all make of this? Do I still have a chance, or does it not sound too good? Thanks for any and all advice you can dish out! Have a great day, -----Annie :)    — Annie R. (posted on June 6, 2001)


June 6, 2001
I went through the same thing. Most of the people you talk to when you call are just customer service reps they can anwser general questions such as status, and such but coverage is determined by RN supervisors and staff physicans.
   — Vanessa C.

June 6, 2001
Hi Annie, she probably meant to say medical review although I can't speak to what she was thinking or the process of the ins co. However, regarding the letter you received, I don't see anything suspicious about the timing. This letter is just to verify other ins carrier liability, that is, the ins co needs this info in order to coordinate benefits. Before claims can be processed, they need to know if their coverage is primary or not, for each covered plan participant. Even though the current info is valid until August, it is not uncommon for such a letter to be sent out couple months in advance. I doubt that this has any bearing on how the ins co will decide. I pray they decide in your favor. All the best.
   — dandjon




Click Here to Return
×