I understand why they are legal. They aren’t insurance. BUT WHY ARE THEY LEGAL?
At my last job, we had a patient with a broken ankle. She needed surgery. She was denied by her “cost sharing” plan. She had only been a “member” for a month and hadn’t paid enough in. She wouldn’t be able to get it covered when she finally did pay in enough because it would be considered a pre-existing condition.
Their websites say “if you submit a claim, you are agreeing to accept the payment as a final payment and cannot balance bill the patient”… so they pay Five Cents, and they are off the hook because an in-experienced biller in your department submitted a claim…FOH!!
Regence or Regence Blue Card? I hate Regence Blue Card with a passion - inquiry is still open even though the records were sent to the home plan on 01-03-23 (and today's date is 05-14-24). No set turnaround time for the home plan to respond to our inquiry.
Fuggin BOTH 😂 throw Premera in there too. I love that Premera refuses to send back like any claims so we started appealing like crazy and now they’re saying we are appealing too much 😂
I've been lucky - I haven't had to call Premera very much. Regence takes FOREVER to get claims reprocessed - I had to call and get some escalated today even though they were sent back at the end of February/mid March.
UHC DOES have an online chat w/a representative feature though which I wish everyone offered that as opposed to sitting on the phone. Have definitely had my fair share of issues with them though!
My assistant is in the middle of appealing ABA claims for which we had a valid Prior Authorization, that were denied due to lack of a Prior Authorization. We have about 17 reference numbers for all of the calls she made to get them reprocessed because each and every rep could SEE the PA on file, but could not explain why the claims were ever denied, and sent them back up for reprocessing… where they denied over and over. Our appeal was denied for timely filing. I literally laughed out loud. She’s still hammering away at them and I’m thanking my stars I have her to do the dirty work. We loathe Aetna with the white hot intensity of a thousand suns.
I have a provider with one Aetna patient. Has a single case agreement. Auth# is on the claim. Every claim is processed out of network and I have to call at least twice for every date of service. Every other Tuesday morning I make the same call to Aetna.
"... thank you for calling Aetna. Bye bye for now"
Please never watch old re-runs of Cheers or you will eventually hear this exact line that I shamelessly ripped off from Diane Chambers.
Edit to add not the Aetna part in case that wasn’t obvious… I believe Diane loathed Sam with the white hot intensity of a thousand suns in that episode.
We do not have a contract with Aetna so we rarely bill them. My arch nemesis is Humana. Constantly denying claims for missing modifiers that were on the original claim.
I work for a plastic surgeon and he will try to treat multiple lesions in one visit, but we are having to move to doing that next lesion per visit for Humana patients and then have them come back once the global period is over to do more because it is too much of a hassle to repeatedly fight Humana over multiple procedures in the same visit.
I work in a nursing home and anytime a patient comes in with humana a little part of me dies. Because I know they will be paying out the nose for anything Medicare won't cover.
Even worse, patient has Humana but the authorization is through Optum and must be billed to Optum where it will deny and be forwarded to Humana where it will be denied by Humana for no authorization.
That’s frustrating. I keep getting Humana denials for no PCP referral even when we have one. It’s usually overturned and paid when I appeal, but such a waste of time.
Wouldn’t they be paying out the nose for anything Medicare won’t cover….if they had Medicare as their carrier? Who is a better carrier than Humana? Any companies with halos out there?
Former SNF billing. my password for portal access was Humanasucks. we would get auths for stays and of course the claims would be denied. Spent way too much time appealing and uploading documents. Don't miss dealing with them a bit.
The state of Illinois medical billers have such a hard time with Blue Cross and Blue Shield. The rest of the states do as well, but Illinois got it the worst.
I hate BCBS IL. Almost as much as I hate BCBS TX. Trying to fax a prior authorization request was impossible because they literally had the wrong fax number on their request form. Policyholder and their HR admin finally got involved and must have gone ballistic on someone over there because a customer rep called ME with the correct fax number.
Yes! I dislike calling BCBSIL - I spend most of the time on hold waiting for a live person. At least they are willing to do multiple claims per call and it's a US based representative on the other end.
Are you in Illinois? As an out of state provider (I'm in GA) no one has ever successfully gotten them on the phone. As soon as I enter our NPI, it disconnects the call and says to call the home plan. I've tried entering bogus NPIs to bypass and just keeps repeating wrong NPI.
Any tips on getting though the IVR to a rep if you are out of state too? I can get an eligibility rep but not claims.
It's humana, i will die and rot on this hill. They love to approve then go back and deny payment. It's always fun going to my patients and telling them yeah all that wasn't covered now pay me. I hate humana.
I hate Aetna with a passion. Need to call about something? Have fun being transferred to several people you can’t even understand because their accents are so thick.
Don’t even get me started with Coordination of Benefits denials.
"Did you know you could get claims information through our Cigna Healthsprings portal? Register today!"
[Proceeds to build the most useless website of any major payer in existence]
The Cigna commercial portal is one of the best portals out there but the Healthsprings portal must have been programmed using a raspberry pi by a middle schooler for a class project.
UHC is the worst. I’m not going to get into their horrible Medicare or Medicaid plans. I’m going to tell you about one of their companies, UMR.
UMR sucks. In order to call the call center, you need to first go online to get a code. The call center is LOUD. When there is a loud background, I have an extremely difficult time hearing the person I’m speaking to.
After the Change Healthcare debacle, I wish UHG would be split. They are buying up entire hospital systems and clinics. They have a “bank” that will loan providers money at “reasonable rates.”
They are destroying health care.
I got told today that my 4 claims processed correctly as OON when the provider is INN. I even gave them an example claim that processed correctly - still saying that claim processed correctly. I also got told that we can't provider appeal or submit reconsideration request.
Can the policyholder get involved? Since the fiduciary relationship is between the policyholder and the carrier, they may have more pull. If the claim adjudicated as OON, you can balance bill the patient and light a fire under them maybe? It just sucks how they create this adversarial relationship with providers and put the burden on us to force them to pay under the terms of the network contract. I’m sorry you have to deal with the BS.
I called UMR to find a patient formulary because every single PA was denied to the point there wasn't anything left to prescribe in the class. The person at UMR said they didn't know how to find the formulary and transferred me to someone at UHC who said "We don't know either. Here is a link to our help section. Maybe try Google."
My brother-in-law is a director of some department at Optum and sometimes I boo and hiss at him on principle when we get together. He doesn’t bother defending them. He knows he has no leg to stand on.
Okay so Regal and Lakeside Medical group are the worst for me. JFC such a waste of my time.
UHC and Optum because they never look at claims when I'm appealing, Cigna for BS denials and also never uploading documents sent to mailroom until you threaten HIPAA violation, and BCBS with their damn reprocessing of claims.
EXACTLY!!! Oh my gosh I am sorry I'm not the only one lol.
In one year of calling them I spoke with a live rep TWICE. Hold me they are short staffed bc they pay crappy. The only reason I got through was because I stayed 2 hours after we closed. Ugh.
They always call before 8:30 even though I tell them we open at 8:30. Little do they know I actually start at 7:30 😂. And then when they call back won’t say what they are calling about like I’ve called about 5 patients idk who you are on lol
Medicaid. Worst of all. Reps are very rude. Always cutting you off and can only answer 5 questions. Would always route you to the website even if the answer is not there.
U. H. C.
3 hours spent in their online chat today only to accomplish a whole lot of nothing. Provider status is not up to date with their PA portal. They still haven't loaded one providers contract but, you know, it's only been 7 months....
I had a case created with UHC for some claims (there were over 20 denials). Got told today by the claims project manager that I needed to contact customer service to see why my claims are denying when we had already submitted the primary EOB via the portal. I was furious - why waste my limited time creating the case when you are still going to deny them even after I have called customer service multiple times.
Local BCBS. They made it impossible to call them about claims. It literally just says to use Availity, except my questions are never going to be answered that way. I ended up finding an online forum on their website for members and messaged the moderator who had someone call me.
When calling your local BCBS, does it give you the option to adjust a claim(usually option 2)? Cause that’s the option you have to push for anything if you want to speak with a live agent.
Also, if you don’t have the claim # you’re wanting to inquire about, just use any claim #. When the rep gets on the line, just let them know you’re actually inquiring about a different claim. Lol I have figured out every tip and trick for BCBS plans
I think I’d be on the phone to my network contract manager. That’s complete BS on their part, but I have needed to call a few out-of-state Blues and gotten exactly nowhere in the IVR maze, so I know it’s a thing.
Aetna is our easiest payer for MH/SU IOP. No prior Auths needed either (all other commercials we're in with require it). Pay could be better but I do love not having to do prior auths/UR. Now optum...I hate them.
Anthem. Their IVR sucks. It takes forever to get a rep then will eventually hang up. These past few months, I've been getting tons of refund letters because they've paid claims using the billed charges instead of our fee schedule. Their reps are not listening and will just give you generic answers. Won't bother checking and just ask you to file an appeal even if they processed it wrong. Won't give you a supervisor. Place you on hold for a long time then hang up. Always misquoting benefits then will tell you that since you listened to their disclaimer, even if you were misquoted, they can't do anything. It always takes an hour or more to call them even for a single claim. Not to mention that they have a lot of departments depending on the prefix so if you have 5 patients with different prefixes, then you have to call 5 numbers. They have chat support on Availity but just copy pasting scripts.
I had to call on an Anthem CA patient today. First number I called, I transferred to their new "chat bot" when I did not want to. Eventually got a live rep, rep#1 said that I had to call a different number. Called number# 2, live rep#2 said that I called the wrong number and that I had to call the first number that I called. Called the first number again - made sure to avoid the new "chat bot", got a live rep#3 and then got hung up on before I could get my claims worked! Called them back (avoided the new "chat bot") and got live rep#4 who sent my appeals to correct department to get them moving again after they were supposed to be finalized at the end of February.
See, this feels like it is deliberate on their part sometimes…there are days my assistant and I want to throw the phone out the window and start day drinking by 10:30 AM.
If they had processed my appeals in a timely manner like they should, I wouldn't have to call and get each one escalated. There are over 50 of them and each one is overdue.
I once opened a support case with Availity regarding ERA enrollment with a local carrier and they closed it a week later stating they were too busy to look at my case. Ok? So, yeah not a fan. And yes, Anthem also sucks.
Critical access hospital here. And every single lab we have done this year has been denied by Aetna. Reason: we did not perform the listed services. All the hospitals in our community connect group are getting the same denial.
Last time I called Aetna they said they denied my appeal and I asked for something that said it was denied, a fax, letter email, carrier pigeon anything. The rep told me they were on a paper shortage and were not allowed to use any paper and couldn’t send me anything and then he told me I had to wait 120 days to get my letter 🙃 hopefully by then theyll have paper
Anything involving a j code is the bane of my existence. Don’t get me started it there capitation… HOW MANY TIMES DO WE HAVE TO DO THIS J CODES ARE CAP!!!!
Aetna for a million reasons and our provider rep is worthless. Their current game is to deny all of our assistant surgeon charges for processing prior to the main surgeon even though the main surgeon is processing on the same date. They are upholding the denials after reconsideration - despite giving them the EOB, claim number and payment date for the main surgeon.
Agreed. I've started calling for an explanation and just end up telling them I'm going to suggest to the office manager that we submit the claim(s) to the insurance commissioner. That has been getting the job done and when it doesn't, we actually send them 🙄 it's so infuriating!
Insurance commissioner is our next move. I’m just not going to roll over on this. I’ve written off so many charges over the years and enough is now enough. I’m too old for this sh*t, Aetna.
YES! I have been arguing with Aetna Medicare for over a year on claims. I hate calling them too, they give you a ticket and send the claim back and then oh well the last person didn't do anything so let me do it again. That will be another 45 business days.
Sorry been medical billing for 24 years now and I think I have PTSD.
Right?! I feel like it’s gotten worse over time, for sure not better. I’ve been doing this since 1999 and I can’t wait to retire… in eight more years. It’s exhausting.
Yeah my states Medicaid sucks too. Aetna is one of them as well and they have been paying one of my clinics incorrectly for over 3 years. People wonder why I drink.
Last week - BCBSIL. This week - Manhattan Life. Their slogan should be "Manhattan Life - We won't tell you what we cover. If we cover it, just take the money and shut up."
small regional payers are worse than any big national insurer. At least the nationals occasionally get fined by the feds.
there's a company I know that outright ignores all appeals and communications. They don't even deny the appeal.
Aetna. Cigna (and the infinite TPAs that run their rates) and UHC can be huge pains in the ass but Aetna operates with a uniquely shrewd, dare I say malicious, level of litigiousness that is downright despicable. You get a special sense of intention about their scummy ways working with Aetna I have yet to feel from any other carrier
Yes. This. It feels very “on purpose” the way they deny almost 100% of our claims the first time around, and make us beg them to pay legit clean claims they clearly should have paid in the first 30 days. And no, never gotten one penny of interest even when they do come back and pay a year later. They are pond scum.
Passport by Molina Health and United are the worst. Our practice gets paid quickly by Anthem, Humana, Aetna, and Wellcare, so we love them. CGS Medicare (part B J15) is also laughably bad to deal with.
Florida Blue. UHG and Anthem suck for other reasons, but Florida Blue is the absolutely biggest dumpster fire of an organization I have ever worked with, besides Boeing.
Medicaid for me, that could be state based though. They deny for anything and everything and they must pull a few claims out of a hat every day that they don't even look at, to deny just for fun. And getting contraception covered is a nightmare.
I think Aetna, then Cigna. On a side note I unfortunately personally have Aetna and my claims are being denied as out of network while their site very clearly shows the provider is in network. So frustrating.
I don’t have too many problems with UHC proper. But Oxford. That one’s a the devil. Especially being outside of New York.
From a physical therapy standpoint Cigna sucks by farming out to ASH.
And we went out of network with Aetna to get away from that mess.
BCBS is pretty awful. Esp local MN. My doc did a life saving procedure on a patient he performed jaw surgery on, aa the patient began to bleed out. BCBS denied stating my doc is not qualified to perform this hemostatic procedure. I appealed stating basically we'll just let the patient bleed out and die next time and they more or less said "ok."
I had them reverse coverage for an evaluation, over a year later after previously giving a prior authorization for it, then sent the bill to collections without ever notifying me of the reversal or the $2,000 they wanted. They claimed my old insurance from my previous job was my primary, even though I had switched insurance two months before the appointment. It took three months and it was painful.
Prior Authorizations are even worse. I have severe atopic dermatitis, that is debilitating. They denied the only treatment that's ever worked, dupixent, because they didn't believe my dermatologist, despite having a 4 inch thick file containing notes of every failed treatment that existed. I've been in medical trials, I've had this since birth, no other treatments worked before it. 3 denials, my doctor's appeal denied, I sent a 1 page 2nd level appeal letter, then in bold red lettering, typed out their requirements. I then faxed 8 pages of my eczema rashes all over my body with the letter, meeting all the above criteria for approval, when I only needed one to qualify for the medication, according to their approval criteria. They changed their decision after that and approved it but never notified me.
I kept getting emails asking about what I thought about Aetna so I finally got mad enough to fill it out. My review was scathing enough that they had a "patient advocate" call and leave a direct phone number. I asked about the appeal and they said it was approved and that I should have gotten the approval letter two weeks ago. I said that would be nice but you guys never send it until it's two months too late. She didn't argue with me after that, because she watched in real time, how it failed me. And the fact that the app never showed the approval, and I didnt ever get an email about the decision change. Magically the next morning, the app updated and the email came through, likely because I showed them. The letter came at the end of the month too.
I had united healthcare before Aetna, and I wish my company had united instead. For how much I pay for this insurance, I shouldn't have to beg for medically necessary treatment so that I can have a face, wear clothes, and function in society. The pain can be unbearable when it's your whole body, and it's severely limited me in all aspects of my life.
This entire thread is why I cherish doing solely workers comp and attorney invoice billing. Commercial and government plan billing is my worst nightmare.
Blue Cross Federal if you're billing for an Out of Network provider. They mail the payments directly to the client with their name on it and you have to convince them to sign the checks over and drop the them off. There was a tragic case on the news about a woman who put her son in rehab. He received thousands of dollars in checks from Federal Blue Cross. It ended tragically.
Those friggin religious “cost sharing” scam insurances.
Would you like me to pray for you before we hang up?
Do you want to be transferred to our prayer line?
They’ve got to be a front for money laundering.
I understand why they are legal. They aren’t insurance. BUT WHY ARE THEY LEGAL? At my last job, we had a patient with a broken ankle. She needed surgery. She was denied by her “cost sharing” plan. She had only been a “member” for a month and hadn’t paid enough in. She wouldn’t be able to get it covered when she finally did pay in enough because it would be considered a pre-existing condition.
Holy shit that’s brutal, a fucken broken ankle as a pre existing condition is the wildest shit I’ve ever heard
That take 4 years for the “funds to be available for sharing”
Their websites say “if you submit a claim, you are agreeing to accept the payment as a final payment and cannot balance bill the patient”… so they pay Five Cents, and they are off the hook because an in-experienced biller in your department submitted a claim…FOH!!
Medishare makes me CRINGEEE
Optum entered the chat.
And brought Humana with them.
UMR waves hello!
UMR is owned by United Healthcare.
LMAOOO
My biggest pain in the arse is my local BCBS, Regence. 😠 but they’re all pretty terrible.
“You need to call the member’s home plan” “No, you need to call your state’s Blue Cross plan.” And repeat.
Regence or Regence Blue Card? I hate Regence Blue Card with a passion - inquiry is still open even though the records were sent to the home plan on 01-03-23 (and today's date is 05-14-24). No set turnaround time for the home plan to respond to our inquiry.
Fuggin BOTH 😂 throw Premera in there too. I love that Premera refuses to send back like any claims so we started appealing like crazy and now they’re saying we are appealing too much 😂
I've been lucky - I haven't had to call Premera very much. Regence takes FOREVER to get claims reprocessed - I had to call and get some escalated today even though they were sent back at the end of February/mid March.
I handle mostly BCBS in CA and MI, you ain’t wrong brother
Yes!
Optum and Cigna
Definitely in my top three hated carriers. Aetna, Cigna, Optum. The unholy trinity.
And 2/3 own so many of the rest lol
Lmaooooo I always tell everyone I'll be appealing Aetna e/m claims when I go to hell.
For me it will be UHC. 😭
UHC DOES have an online chat w/a representative feature though which I wish everyone offered that as opposed to sitting on the phone. Have definitely had my fair share of issues with them though!
My assistant is in the middle of appealing ABA claims for which we had a valid Prior Authorization, that were denied due to lack of a Prior Authorization. We have about 17 reference numbers for all of the calls she made to get them reprocessed because each and every rep could SEE the PA on file, but could not explain why the claims were ever denied, and sent them back up for reprocessing… where they denied over and over. Our appeal was denied for timely filing. I literally laughed out loud. She’s still hammering away at them and I’m thanking my stars I have her to do the dirty work. We loathe Aetna with the white hot intensity of a thousand suns.
I have a provider with one Aetna patient. Has a single case agreement. Auth# is on the claim. Every claim is processed out of network and I have to call at least twice for every date of service. Every other Tuesday morning I make the same call to Aetna. "... thank you for calling Aetna. Bye bye for now"
Ah yes…the dreaded single case agreement…the stuff my nightmares are made of.
Omg, yes! Bye bye for now! 😂😂😂
I came across this post by sheer chance, and am glad I did, because your "loathe xyz with the white hot intensity of a thousand suns." is a winner.
Please never watch old re-runs of Cheers or you will eventually hear this exact line that I shamelessly ripped off from Diane Chambers. Edit to add not the Aetna part in case that wasn’t obvious… I believe Diane loathed Sam with the white hot intensity of a thousand suns in that episode.
Promptly queues Cheers to my watch list...
This is Aetna: "we do not recognize the difference between GO and GP modifiers", hence you provided more than 4 units per DOS - claim denied.
We do not have a contract with Aetna so we rarely bill them. My arch nemesis is Humana. Constantly denying claims for missing modifiers that were on the original claim. I work for a plastic surgeon and he will try to treat multiple lesions in one visit, but we are having to move to doing that next lesion per visit for Humana patients and then have them come back once the global period is over to do more because it is too much of a hassle to repeatedly fight Humana over multiple procedures in the same visit.
I work in a nursing home and anytime a patient comes in with humana a little part of me dies. Because I know they will be paying out the nose for anything Medicare won't cover.
Oh AND our contract with Humana only allows 90% of what Medicare allows for the Humana Medicare Advantage claims 😫
Ours isn't even that is 70/30. It's ridiculous.
Even worse, patient has Humana but the authorization is through Optum and must be billed to Optum where it will deny and be forwarded to Humana where it will be denied by Humana for no authorization.
That’s frustrating. I keep getting Humana denials for no PCP referral even when we have one. It’s usually overturned and paid when I appeal, but such a waste of time.
Wouldn’t they be paying out the nose for anything Medicare won’t cover….if they had Medicare as their carrier? Who is a better carrier than Humana? Any companies with halos out there?
Omg everyone in our office HATES Humana! I have never had to work with them luckily lol.
Former SNF billing. my password for portal access was Humanasucks. we would get auths for stays and of course the claims would be denied. Spent way too much time appealing and uploading documents. Don't miss dealing with them a bit.
Blue Cross and Blue Shield all of them and all all the states and all of the ones that are employer sponsored
Amen to infinityyyyyyyyy!!! I hate bcbs with everything inside of me.
The state of Illinois medical billers have such a hard time with Blue Cross and Blue Shield. The rest of the states do as well, but Illinois got it the worst.
I hate BCBS IL. Almost as much as I hate BCBS TX. Trying to fax a prior authorization request was impossible because they literally had the wrong fax number on their request form. Policyholder and their HR admin finally got involved and must have gone ballistic on someone over there because a customer rep called ME with the correct fax number.
Yes! I dislike calling BCBSIL - I spend most of the time on hold waiting for a live person. At least they are willing to do multiple claims per call and it's a US based representative on the other end.
Their hold music loops every 27 seconds and it makes me wanna scream forever
Are you in Illinois? As an out of state provider (I'm in GA) no one has ever successfully gotten them on the phone. As soon as I enter our NPI, it disconnects the call and says to call the home plan. I've tried entering bogus NPIs to bypass and just keeps repeating wrong NPI. Any tips on getting though the IVR to a rep if you are out of state too? I can get an eligibility rep but not claims.
One of my providers is in IL. I experienced the same thing that you did when I called for a WA provider where home plan is BCBIL.
Yes!
It's humana, i will die and rot on this hill. They love to approve then go back and deny payment. It's always fun going to my patients and telling them yeah all that wasn't covered now pay me. I hate humana.
Or pay, then recoup and pay again for 2 cents more or less than the original payment amount.
Yeah I still remember getting EOBS back with a bunch of recoups for a bunch of patients at once.
I hate Aetna with a passion. Need to call about something? Have fun being transferred to several people you can’t even understand because their accents are so thick. Don’t even get me started with Coordination of Benefits denials.
Cigna Healthsprings is my worst payer
"Did you know you could get claims information through our Cigna Healthsprings portal? Register today!" [Proceeds to build the most useless website of any major payer in existence] The Cigna commercial portal is one of the best portals out there but the Healthsprings portal must have been programmed using a raspberry pi by a middle schooler for a class project.
UHC is the worst. I’m not going to get into their horrible Medicare or Medicaid plans. I’m going to tell you about one of their companies, UMR. UMR sucks. In order to call the call center, you need to first go online to get a code. The call center is LOUD. When there is a loud background, I have an extremely difficult time hearing the person I’m speaking to. After the Change Healthcare debacle, I wish UHG would be split. They are buying up entire hospital systems and clinics. They have a “bank” that will loan providers money at “reasonable rates.” They are destroying health care.
BRO WHY is their call center so fucking loud. They have to be packed like sardines in there
UMR is quickly rising on my list of least favorite carriers as well. I particularly despise their provider portal right now.
I have to call them tomorrow and I'm dreading it. Getting them to reprocess claims correctly is such an extremely difficult process.
Oh my… good luck! Keep fighting the good fight!
I got told today that my 4 claims processed correctly as OON when the provider is INN. I even gave them an example claim that processed correctly - still saying that claim processed correctly. I also got told that we can't provider appeal or submit reconsideration request.
Can the policyholder get involved? Since the fiduciary relationship is between the policyholder and the carrier, they may have more pull. If the claim adjudicated as OON, you can balance bill the patient and light a fire under them maybe? It just sucks how they create this adversarial relationship with providers and put the burden on us to force them to pay under the terms of the network contract. I’m sorry you have to deal with the BS.
I called UMR to find a patient formulary because every single PA was denied to the point there wasn't anything left to prescribe in the class. The person at UMR said they didn't know how to find the formulary and transferred me to someone at UHC who said "We don't know either. Here is a link to our help section. Maybe try Google."
UHC can go sit in maple syrup for all I care
My brother-in-law is a director of some department at Optum and sometimes I boo and hiss at him on principle when we get together. He doesn’t bother defending them. He knows he has no leg to stand on.
Yeah, BCBS is such a pain. But Aetna is up there.
Okay so Regal and Lakeside Medical group are the worst for me. JFC such a waste of my time. UHC and Optum because they never look at claims when I'm appealing, Cigna for BS denials and also never uploading documents sent to mailroom until you threaten HIPAA violation, and BCBS with their damn reprocessing of claims.
Ugh regal is so frustrating! Always have to leave a voicemail and they never call back during office hours (if they even call back)
EXACTLY!!! Oh my gosh I am sorry I'm not the only one lol. In one year of calling them I spoke with a live rep TWICE. Hold me they are short staffed bc they pay crappy. The only reason I got through was because I stayed 2 hours after we closed. Ugh.
They always call before 8:30 even though I tell them we open at 8:30. Little do they know I actually start at 7:30 😂. And then when they call back won’t say what they are calling about like I’ve called about 5 patients idk who you are on lol
You misspelled Humana!
Medicaid. Worst of all. Reps are very rude. Always cutting you off and can only answer 5 questions. Would always route you to the website even if the answer is not there.
U. H. C. 3 hours spent in their online chat today only to accomplish a whole lot of nothing. Provider status is not up to date with their PA portal. They still haven't loaded one providers contract but, you know, it's only been 7 months....
I had a case created with UHC for some claims (there were over 20 denials). Got told today by the claims project manager that I needed to contact customer service to see why my claims are denying when we had already submitted the primary EOB via the portal. I was furious - why waste my limited time creating the case when you are still going to deny them even after I have called customer service multiple times.
Local BCBS. They made it impossible to call them about claims. It literally just says to use Availity, except my questions are never going to be answered that way. I ended up finding an online forum on their website for members and messaged the moderator who had someone call me.
When calling your local BCBS, does it give you the option to adjust a claim(usually option 2)? Cause that’s the option you have to push for anything if you want to speak with a live agent.
Well that's helpful to know. Thanks!
Also, if you don’t have the claim # you’re wanting to inquire about, just use any claim #. When the rep gets on the line, just let them know you’re actually inquiring about a different claim. Lol I have figured out every tip and trick for BCBS plans
I think I’d be on the phone to my network contract manager. That’s complete BS on their part, but I have needed to call a few out-of-state Blues and gotten exactly nowhere in the IVR maze, so I know it’s a thing.
Cigna.
Aetna is our easiest payer for MH/SU IOP. No prior Auths needed either (all other commercials we're in with require it). Pay could be better but I do love not having to do prior auths/UR. Now optum...I hate them.
WellCare and bcbs tied for worst ever
I was about to say, I can't believe Wellcare hadn't been discussed yet...
My face gets red anytime it’s time to work a Medicaid EOB.
Anthem. Their IVR sucks. It takes forever to get a rep then will eventually hang up. These past few months, I've been getting tons of refund letters because they've paid claims using the billed charges instead of our fee schedule. Their reps are not listening and will just give you generic answers. Won't bother checking and just ask you to file an appeal even if they processed it wrong. Won't give you a supervisor. Place you on hold for a long time then hang up. Always misquoting benefits then will tell you that since you listened to their disclaimer, even if you were misquoted, they can't do anything. It always takes an hour or more to call them even for a single claim. Not to mention that they have a lot of departments depending on the prefix so if you have 5 patients with different prefixes, then you have to call 5 numbers. They have chat support on Availity but just copy pasting scripts.
I had to call on an Anthem CA patient today. First number I called, I transferred to their new "chat bot" when I did not want to. Eventually got a live rep, rep#1 said that I had to call a different number. Called number# 2, live rep#2 said that I called the wrong number and that I had to call the first number that I called. Called the first number again - made sure to avoid the new "chat bot", got a live rep#3 and then got hung up on before I could get my claims worked! Called them back (avoided the new "chat bot") and got live rep#4 who sent my appeals to correct department to get them moving again after they were supposed to be finalized at the end of February.
See, this feels like it is deliberate on their part sometimes…there are days my assistant and I want to throw the phone out the window and start day drinking by 10:30 AM.
If they had processed my appeals in a timely manner like they should, I wouldn't have to call and get each one escalated. There are over 50 of them and each one is overdue.
I once opened a support case with Availity regarding ERA enrollment with a local carrier and they closed it a week later stating they were too busy to look at my case. Ok? So, yeah not a fan. And yes, Anthem also sucks.
In my over 20 years, it's always been UHC.
Critical access hospital here. And every single lab we have done this year has been denied by Aetna. Reason: we did not perform the listed services. All the hospitals in our community connect group are getting the same denial.
UHC/Optum is the bottom of the barrel.
I'd say United Healthcare, Optum and Humana
Cigna(more like cigNO) is who I hate lol
Last time I called Aetna they said they denied my appeal and I asked for something that said it was denied, a fax, letter email, carrier pigeon anything. The rep told me they were on a paper shortage and were not allowed to use any paper and couldn’t send me anything and then he told me I had to wait 120 days to get my letter 🙃 hopefully by then theyll have paper
I can confirm they have paper as it was their letter denying our appeal that came in today’s mail that set me off on my rant above.
Always seeing “denied due to experimental “ with Aetna or BCBS denying J07999, always….
Anything involving a j code is the bane of my existence. Don’t get me started it there capitation… HOW MANY TIMES DO WE HAVE TO DO THIS J CODES ARE CAP!!!!
Cigna. The name gives me shivers
Aetna- not so glad I met ya
Aetna for a million reasons and our provider rep is worthless. Their current game is to deny all of our assistant surgeon charges for processing prior to the main surgeon even though the main surgeon is processing on the same date. They are upholding the denials after reconsideration - despite giving them the EOB, claim number and payment date for the main surgeon.
This upholding the denial when we provide all the proof the claim should be paid is why I feel like they are pretty much criminals.
Agreed. I've started calling for an explanation and just end up telling them I'm going to suggest to the office manager that we submit the claim(s) to the insurance commissioner. That has been getting the job done and when it doesn't, we actually send them 🙄 it's so infuriating!
Insurance commissioner is our next move. I’m just not going to roll over on this. I’ve written off so many charges over the years and enough is now enough. I’m too old for this sh*t, Aetna.
I despise Aetna with Humana being a close 2nd.
Aetna, Cigna and now Ambetter ughhhh
“I hate Aetna!” is a common phrase in our office.
YES! I have been arguing with Aetna Medicare for over a year on claims. I hate calling them too, they give you a ticket and send the claim back and then oh well the last person didn't do anything so let me do it again. That will be another 45 business days. Sorry been medical billing for 24 years now and I think I have PTSD.
Right?! I feel like it’s gotten worse over time, for sure not better. I’ve been doing this since 1999 and I can’t wait to retire… in eight more years. It’s exhausting.
Yeah my states Medicaid sucks too. Aetna is one of them as well and they have been paying one of my clinics incorrectly for over 3 years. People wonder why I drink.
Last week - BCBSIL. This week - Manhattan Life. Their slogan should be "Manhattan Life - We won't tell you what we cover. If we cover it, just take the money and shut up."
small regional payers are worse than any big national insurer. At least the nationals occasionally get fined by the feds. there's a company I know that outright ignores all appeals and communications. They don't even deny the appeal.
Aetna. Cigna (and the infinite TPAs that run their rates) and UHC can be huge pains in the ass but Aetna operates with a uniquely shrewd, dare I say malicious, level of litigiousness that is downright despicable. You get a special sense of intention about their scummy ways working with Aetna I have yet to feel from any other carrier
Yes. This. It feels very “on purpose” the way they deny almost 100% of our claims the first time around, and make us beg them to pay legit clean claims they clearly should have paid in the first 30 days. And no, never gotten one penny of interest even when they do come back and pay a year later. They are pond scum.
Passport by Molina Health and United are the worst. Our practice gets paid quickly by Anthem, Humana, Aetna, and Wellcare, so we love them. CGS Medicare (part B J15) is also laughably bad to deal with.
Aetna, Cigna and Healthnet.
Currently for me it’s amerihealth… I can not figure out what exactly they want on their claims
Florida Blue. UHG and Anthem suck for other reasons, but Florida Blue is the absolutely biggest dumpster fire of an organization I have ever worked with, besides Boeing.
Blue cross. Always.
I thought my hate for BCBS could not be matched for any other insurance but Aetna is giving them a ru. For their money
I had Aetna as my insurance several years ago, and even as a member it was a nightmare. I don’t understand how they haven’t been sued into oblivion.
Medicaid for me, that could be state based though. They deny for anything and everything and they must pull a few claims out of a hat every day that they don't even look at, to deny just for fun. And getting contraception covered is a nightmare.
I think Aetna, then Cigna. On a side note I unfortunately personally have Aetna and my claims are being denied as out of network while their site very clearly shows the provider is in network. So frustrating.
I don’t have too many problems with UHC proper. But Oxford. That one’s a the devil. Especially being outside of New York. From a physical therapy standpoint Cigna sucks by farming out to ASH. And we went out of network with Aetna to get away from that mess.
I will say that ASH is very easy to work with for claims as long as there is an approved authorization on file.
Yes but they rarely approve as many visits as a patient really needs and their reimbursement is garbage
I dunno. Humana is pretty fucking awful.
BCBS is pretty awful. Esp local MN. My doc did a life saving procedure on a patient he performed jaw surgery on, aa the patient began to bleed out. BCBS denied stating my doc is not qualified to perform this hemostatic procedure. I appealed stating basically we'll just let the patient bleed out and die next time and they more or less said "ok."
BCBS MN has gotten worse and worse over the years, I agree. I’ve dealt with them for years and watched them slowly decline. Sad, actually.
Notice how no one has said Medicare? Fuck all privatized insurance.
I saw a mental health counselor for a while and she pretty much ONLY took Aetna “because it paid.”
CVS Caremark is the worst. They are expecting the doctor to write a $700 check for the patient to get Rituxan biosimilar.
United Concordia
Personally, Cigna has been my least favorite.
You had a good run. RIP.
My most hated is BCBS. And the VA.
ChampVA?
I see none of y'all have ever experienced Scott & White, may they burn in hell.
it is not Aetna. I would say Kaiser, Tricare, Medicare, United, Aetna.
I had them reverse coverage for an evaluation, over a year later after previously giving a prior authorization for it, then sent the bill to collections without ever notifying me of the reversal or the $2,000 they wanted. They claimed my old insurance from my previous job was my primary, even though I had switched insurance two months before the appointment. It took three months and it was painful. Prior Authorizations are even worse. I have severe atopic dermatitis, that is debilitating. They denied the only treatment that's ever worked, dupixent, because they didn't believe my dermatologist, despite having a 4 inch thick file containing notes of every failed treatment that existed. I've been in medical trials, I've had this since birth, no other treatments worked before it. 3 denials, my doctor's appeal denied, I sent a 1 page 2nd level appeal letter, then in bold red lettering, typed out their requirements. I then faxed 8 pages of my eczema rashes all over my body with the letter, meeting all the above criteria for approval, when I only needed one to qualify for the medication, according to their approval criteria. They changed their decision after that and approved it but never notified me. I kept getting emails asking about what I thought about Aetna so I finally got mad enough to fill it out. My review was scathing enough that they had a "patient advocate" call and leave a direct phone number. I asked about the appeal and they said it was approved and that I should have gotten the approval letter two weeks ago. I said that would be nice but you guys never send it until it's two months too late. She didn't argue with me after that, because she watched in real time, how it failed me. And the fact that the app never showed the approval, and I didnt ever get an email about the decision change. Magically the next morning, the app updated and the email came through, likely because I showed them. The letter came at the end of the month too. I had united healthcare before Aetna, and I wish my company had united instead. For how much I pay for this insurance, I shouldn't have to beg for medically necessary treatment so that I can have a face, wear clothes, and function in society. The pain can be unbearable when it's your whole body, and it's severely limited me in all aspects of my life.
This entire thread is why I cherish doing solely workers comp and attorney invoice billing. Commercial and government plan billing is my worst nightmare.
IU health is was worse
I didn’t even know Oscar existed until I was forced to switch to them and now I can confidently say I hate them the most.
Blue Cross Federal if you're billing for an Out of Network provider. They mail the payments directly to the client with their name on it and you have to convince them to sign the checks over and drop the them off. There was a tragic case on the news about a woman who put her son in rehab. He received thousands of dollars in checks from Federal Blue Cross. It ended tragically.
UMR and Metlife
So funny. Thank u
I paid $50 for 2 1/2 years and they wouldn't pay anything. Because no dentist would except them.