Sprung87: One issue is the people who answer the phone at help centers, patient support, customer service, etc, are working off a script. That's all they are allowed to say, except "I'm sorry about that" or "I apologize about that". That's all they are trained at. That's all they know. They can give a rote answer to only a limited number of things. Get them off the scripts and they are lost. They are instructed to ask for data that is meaningless, or needless. "What's the date of service?" Who cares? There is a serial number and a date on that EOB, and they can read it or punch it in just as well as you or I could. It might be a denial on a bill over a year old and I'm supposed to remember the date and day of the week? But do that enough times, and they hope you'll believe them or will give up. In the meantime, it also lets them "blame the victim": "see, you don't give me the information I need to look that up. Call us back when you know these things so we can keep you on hold for another half hour or more." I've spent over an hour on the phone with these people, at one time, fighting my way towards common sense - "common sense is not so common".
I spent half a day - yes, 4 hours - trying to get through to someone who could explain and fix a denial - they had denied the anesthesia for a mastectomy on the basis of: we can't see a connection between the operation and the anesthesia. The wife in this case finally got on the phone, and asked (very impolitely but delightfully) if they'd pay for the two bullets they thought she was supposed to bite down on.
We got passed rapidly up the line. One wanted an official letter from the hospital explaining the "need". He was told - without a swear word, but in detail - exactly where he could put that letter. We got passed up the line, again. They eventually paid, but they should have paid my salary for the time wasted. (Lord, do I wish I had a recording of that woman!)
This happened twice, two different woman. Tell me that company cared where their money came from. Go on, tell me - and see if you can keep from choking. How long would your nose grow?
Just having to remember that and I wonder what my blood pressure is up to.
I'll bet a congress person, retired or not, doesn't get that kind of hassle. They get, at taxpayer expense, permanent, no-limit, no deductible, no co-pay medical insurance for the rest of their lives.
Grrrr.
It's as if they don't want you to contact anyone who can give you any kind of a logical answer! Hmmmm, now let's see! If it were me, I would probably "go over their heads" and contact someone in the executive office. One place I can think of is their community or public relations office, or barring that, a patient advocacy office. Your header says Geisinger Medical which is a huge system in NE Pennsylvania. (well you knew that!) An outfit of that size must have a patient advocate and in some places I think they are referred to as an ombudsman. Their job is specifically to answer patient inquiries and complaints on a one-on-one basis. With the run-around you've been getting for quite some time now, this certainly needs the services of an ombudsman. See if there is an ombudsman at the Geisinger branch you deal with locally. Barring that, their main headquarters and hospital is in Danville. I don't know how far you are from there but this warrants getting action from there, even if you have to drive there. If there have been numerous complaints lodged against the call center's "service," or lack thereof, from other patients, they would certainly know about it in Danville! If you ask about a patient advocate/ombudsman are are only greeted with a "huh?" and shrugged shoulders, ask to talk to the community relations office. As the title says, they talk to the community, i.e., the patients and you are a member of that community. So they have to talk to you. Just tell them the call center does NOT serve its patients well and that you want two-way communication with your provider. Unfortunately call centers and the like are the way of business in the 21st century, however. But if enough people say "enough is enough...."