One such encounter went like this:

Me: “Hi. I’m calling about my daughter’s ambulance and hospital charges. I haven’t been able to reach my grievance coordinator about the appeal.”

Representative: “I can help you.”

**Me: **(Genuinely excited.) “Great!”

Representative: “Oh, I see your daughter turned 18. I can’t discuss her information with you.”

Me: “I sent a release of information form by mail, fax and email. I also faxed our conservatorship papers.”

Representative: “I’m sorry, it’s not on file. What office did you send it to?”

Me: (I give the information.)

Representative: “That’s the wrong fax number. Let me give you the correct one.”

Me: “I’m not inventing numbers out of the ether. This is the third new fax number I’ve been given. Are the address and email inaccurate too?”

Representative: “I’m sorry, but I can’t discuss your daughter’s claims with you without this information. Can you put her on the phone to give verbal consent?”

**Me: **“I can’t put her on the phone. She’s currently in a treatment center and has no access to a phone, which is why I have a conservatorship to help with her medical care.”

Representative: “I’m sorry, ma’am. There’s nothing I can do without the forms or her verbal consent.”

Me: “Who do you think pays the insurance premium and all her providers? I’m just trying to settle her claims, and I don’t know what we owe without access.”

Representative: “I can only answer general questions.”

Me: “OK. From the bills I’ve received, we’re being charged out-of-network fees for the ambulance, ER, ER doctor and hospital.”

Representative: “Was this out of state?”

**Me: **“Yes.”

Representative: “Hang on, I have to transfer you.”

I was on hold for another 15 minutes, and then got cut off. I called back, was transferred twice and then repeated a version of the above conversation before resuming — with a grievance coordinator!

Grievance coordinator: “The ambulance and ER facility were both out of state and out of network.”

Me: “A treatment center called for an ambulance. I wasn’t given a choice of who responded or where they took her.”

Grievance coordinator: “They used out-of-network providers.”

Me: “They dialed 911. No one stops to ask the closest ambulance what their network status is.”

Grievance coordinator: “They did transfer her to an in-network hospital, but the physicians were not participating providers.”

**Me: **“Under the No Surprises Act, insurance must cover all providers in the case of an emergency, whether they are in network or not — even if out of state.”

(There was a long silence.)

Me: “Are you still there?”

Grievance coordinator: “Yes, ma’am. Once you get the conservatorship papers to us, we can look at those claims. Is there anything else I can help you with?”

Me: “Apparently not.”

  • danA
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    5 months ago

    Just be sure to check if you’re in a one-party or two-party consent state. If it’s a two-party consent state you’ll need their permission to record the call.