I have a high co-payment for my shots (30%). Af a result I meet my max copay for the year quite early and every year three years running it's a chore to get them to notice and pay me back.
To share the pain, I've started keeping a call log:
Health Net Call Log
Tracking the progress of the 2008 Maximum Copayment Liability Notification (Out of Pocket expenses)
2008 Payments to Caremark - submitted
Payments to Caremark after form submitted
Total 2738.75 (1238.75 after 1500)
Talking to Rodney
Asked how I could fax in the 2008 claim
Claiming that I have to mail it it.
I explained that I faxed it last year and it got lost three times when I mailed it. He's checking again
Says the fax number is 818-676-5008 Attn Claims and it will get scanned it
[later that day]
Tried fax number - it answers but then hangs up (tried 3x)
Faxed to main number to "Claims"
Finally just sent it to the main fax number 800-204-3778 Attn Claims and that seemed to work and I didn't get a bounce fax soon after.
Talking to Robert
Has OOP for been scanned in?
Yes, Received on 3/27/08 (that has to be it.)
Takes 45 business day (= 9wks, that would be 5/23/08)
Talking to Betty
Currently being reviewed (they check all expenses)
Talking to Deborah
On 3/28/08 send to claims by mistake (that was probably me though they told me to do that).
Form needs to go to specific person (Carmen), not claims, it got scanned in but there it will sit until someone actually does something with it
Deborah is sending all information to her.
Deborah says that if no name on the fax then it does get scanned in, but just sits there
Talking to: Marie
Form sent back with 2007 information. (That's deliberately dense of them.)
Accumulator spreadsheet for 2008 empty and they need to update it.
Will resubmit and expedite
Says request does go to claims (but likely then gets shuttled off to Carmen)
Talking to: Brendisia
on hold - told her last person I spoke to was Marie and was a couple of weeks ago.
Everything updated on Accumulator spreadsheet [well that's good news]
Have met OOP for 2008
OOP status has date of 5/30/08 [slow slow slow]
back on hold while she checks on refund check
Asked that information be forwarded to pharmacy
Doesn't show overpayment
I will have to look up my own copy
She says that Marie is working today and that when I call back I can ask for her.
[Didn't have time to call back later that day]
Checked my copy of the Maximum Copayment Liability Notification
My total at the time was $1643.25 submitted 3/25/08.
Called Theresa at Caremark
866-833-3752 option 1 x4141
to see if there's a way to check if OOP processed
They have to put a claim through to be able to check.
I will call next week when I need more.
Talking to Tara (Helpful - familiar with OOP Max)
Asked if Marie is working today (I don't think she was)
Tara sees the accumulator sheet and
not sure of status of overpayment
Will send email to Carmen (who handles these things) about the OOP overpayment reimbursement (told Tara 1238.75)
also asking how to let pharmacy know that OOP Max has been reached.
When she hears back tomorrow she will call me on the cell phone.
Geez, I should at least get a merit badge for this pain.
One of the final reasons that I went to Kaiser when I had a choice was the endless stupid trying-to-straighten-out-insurance-crap that wore me down faster than any illness or injury I ever had. It sucks.
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