Hospital Insurance Health Care Scam Runaround Doctors Do Not Accept Part 2 September 14, 2017


good morning thank you for giving a call ambetter peach state okay so you would you say your name is yeah Bria okay okay I remember the member ID number is or name date of birth last four of social oh okay and of course can I have you verify your specific first and last names going forward in your relation to the member please Teresa Richardson I'm his wife okay miss Richardson certainly are you calling in to make a payment today or for a different information I'm calling for different information we're trying to find out about some services and why they were denied from January of this year January 5th 2017 okay the services in which you're referring to are they for yourself or for mr Richardson or my husband Levi okay ok, I can see he does not have an authorized caller for his account okay mr

Richardson good morning how are you today all right yes sir definitely just call protocol gonna have you verify your full name date of birth and last words of social perfect and do you give permission today for Miss Teresa Richardson's to go ahead and speak on your behalf yes discuss anything under your health profile or make any requests yes thank you so much have a wonderful evening miss Richardson could you give me those dates of service in which you're calling in for today yes the date of service is January 5th 2017 okay okay you tell me the total amount not the amount that they're billing you every charge okay the total amount is six hundred and eighty nine dollars yes the claim number is Q 1 2 3 m PE 2 1 6 8 5 information for you yeah from st Joseph yeah that was all st Joseph but they told us that was only we called earlier and they they told us that we couldn't go to Memorial that we could only go to st Joseph's oh we couldn't go to my primary care doc well right but we also called and asked them about Memorial and they said we couldn't go to Memorial they said we had to go to the st Joseph's that we would what we if you remember I'm trying to go to my primary doctor I don't well apparently that's what is saying that she's not in the network either so that says right here well they got us didn't they said never I didn't catch 22 I know I see that what they're doing there's no your pardon yes man so definitely I'm currently pulling up this information for use regarding that claim I can see where it was possibly for the doctor does Ashley Sutherland is that correct yes ok certainly I do see that doctor the total amount of $689 as well let's see here I'm currently showing that the claim was not submitted from the doctor's office within the required time therefore there was nothing paid out on the claim I'm not showing where there's anything for you as the members that you would have to pay out of pocket as far as any coinsurance a copay and that's due to the doctors did not submit this claim for charges in time for us to process okay so so then in other words so is there the doctor is trying to bill us yeah the doctors trying to bill us now so can you rerun can you rerun it or are they just out of luck at this point they are out of luck it is definitely their mistake because they should have sent the claim to us for us to pay one day half of the benefits on time so it's a matter of them sending it to us on time okay so so then we don't owe anything at this time then no ma'am if they are insisting that you know anything have them give us four or referred them to give us a call we can certainly get them over to provider services and they can discuss the information regarding why the claim was not paid okay yeah okay so yeah they're trying to force us to pay the bill right now so so we will have them call you at provider services and then they discuss with you why what why they look missed out correct okay okay so is there anything else that we need to do at this time I know ma'am nothing except contact them within Oh you discussed the claim is with us as your insurance and you verified that it denied for timely filing certainly there's nothing that you would all do to of course it is at their fault for not submitting the claim in the time that they should have okay okay thank you very much for you was there anything additional have to do to assist or inform miss Richardson Oh to an end of the call survey to help improve services I can't think of if you can give me a primary care doc he's looking for a primary care doctor we can't find anybody even here that will actually accept our insurance and so he's had even when it's showing up on and better and we call they still say that they won't accept and better so okay quick question on the website and I will say this because some of the doctors they either don't contract which means they don't accept the insurance anymore which is that their choice or of course they're just not taking new patients which today will possibly say or we don't accept the insurance but the fact is they don't accept new patients if you've located and tried to call the doctors with it within a 60-mile range what you can do is a single case agreement which means you can seek out a network doctor for your services and then of course if they agree to treat you they would just need to give us the insurance a call and we can set up a single case agreement for that for them to treat you going forward okay I can also do it fish today and just a tidbit of information okay okay a single paste agreement okay so so he could actually try to work out a single case agreement with the doctor he was going to and see if they will do that because he was going to his doctor and they actually that's why all this started was back in January who's trying to go to his original doctor but then they said then they wouldn't accept our insurance right some doctors definitely again they will not accept the insurance and it's at their choice but if you cannot locate an in-network doctor emphases on in-network within sixty miles within a 60-mile radius you're able to do a single case agreement and you can with that basically does is give you the option to go see an out-of-network doctor but the thing is they have to agree to want to take you on as a team case entreat you when they do or if they do agree they need to give us a call that way we can set that information up for them to treat you okay so can we go to someone in South Carolina a doctor in South Carolina well you have to stay within your state because all states are not covered oh it's insurance all states don't take the same specific insurance under the marketplace okay because I was just thinking they're not very far away so okay okay so anything else all right thank you very much a year's welcome again was there anything additional I could do to assist and could I interest for an end of the class survey to help improve services sure I'll do the survey okay well definitely miss Richardson I do thank you for giving us a call here specifically at another four Peach State this visit the website of ammeter health

com where you can see and do your own building benefits and also making payments online with that being said is it okay if I now switch you on just a 30 second holds and you will go to therapy yes yes that's fine thank you okay you want

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