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What is the name of your state? Minnesota
I decided to have Lasik laser eye surgery in May 2003. My vision coverage is through "Company S", which is affiliated with "Company U", my health insurance company (and incidentally, my employer). Company S offers access to discounted laser eye surgery procedures.
I made an appointment with the provider of my choice. I told the care coordinator ("Miss H") that my vision coverage is through Company S. Company S does not issue its own identification cards, so I faxed her a copy of my Company U health insurance card. Benefits could have been verified by calling the member services number on the card. Miss H told me she had never heard of Company S and that I was not eligible for a discount.
I decided to have my surgery through this provider anyway and agreed to pay the entire cost.
In November 2003, I learned that a coworker, who has the same vision coverage through Company S, is receiving the discount for the same surgery by the same doctor at the same clinic.
I immediately contacted Company S, and was told that this is not a reimbursement, but rather a discount by the provider and that I would have to work it out with the provider.
When I spoke with the business manager ("Miss K") of the provider, she said that they have no record that I identified myself as a participant with Company S. The fact is that I did tell the Miss H that I am a Company S participant when I made the initial appointment and again when we scheduled the surgery. Miss H did not put any documentation that I was a participant with Company S in my file.
Miss K verified that they do have a copy of my health insurance card in my file, but it does not mention Company S on it anywhere. Miss K said that "Company U owns Company S but they are two different entities", so they did not call member services to verify any benefits or participation.
Miss K did say that if I had brought this matter up earlier (such as within 30 days), they'd be more amenable to issuing a refund, but because it is now 8 months later, she's only willing to "meet me half way". I argue that had I known the discount was available at the time of service, I would have pushed the issue then. I had no reason to believe that anyone was being deceptive. The reason it took so long for me to raise the issue is that I only recently learned of the error.
Miss K is going to talk to her president and call me back next week with a proposed resolution.
The discount is 20% of the $4500 fee -- $900. I feel the error was made by Miss H, and I am entitled to the entire discount.
I'm looking for some advice on how to approach this when the business manager calls me back next week. If she offers less than the full amount, what do I do? Is it worth pursuing in small claims court? They say they don't have documentation that I said I was a participant with Company S, but I don't have documentation that I did tell them, because it was verbal. It is my word against theirs.
Thank you!
I decided to have Lasik laser eye surgery in May 2003. My vision coverage is through "Company S", which is affiliated with "Company U", my health insurance company (and incidentally, my employer). Company S offers access to discounted laser eye surgery procedures.
I made an appointment with the provider of my choice. I told the care coordinator ("Miss H") that my vision coverage is through Company S. Company S does not issue its own identification cards, so I faxed her a copy of my Company U health insurance card. Benefits could have been verified by calling the member services number on the card. Miss H told me she had never heard of Company S and that I was not eligible for a discount.
I decided to have my surgery through this provider anyway and agreed to pay the entire cost.
In November 2003, I learned that a coworker, who has the same vision coverage through Company S, is receiving the discount for the same surgery by the same doctor at the same clinic.
I immediately contacted Company S, and was told that this is not a reimbursement, but rather a discount by the provider and that I would have to work it out with the provider.
When I spoke with the business manager ("Miss K") of the provider, she said that they have no record that I identified myself as a participant with Company S. The fact is that I did tell the Miss H that I am a Company S participant when I made the initial appointment and again when we scheduled the surgery. Miss H did not put any documentation that I was a participant with Company S in my file.
Miss K verified that they do have a copy of my health insurance card in my file, but it does not mention Company S on it anywhere. Miss K said that "Company U owns Company S but they are two different entities", so they did not call member services to verify any benefits or participation.
Miss K did say that if I had brought this matter up earlier (such as within 30 days), they'd be more amenable to issuing a refund, but because it is now 8 months later, she's only willing to "meet me half way". I argue that had I known the discount was available at the time of service, I would have pushed the issue then. I had no reason to believe that anyone was being deceptive. The reason it took so long for me to raise the issue is that I only recently learned of the error.
Miss K is going to talk to her president and call me back next week with a proposed resolution.
The discount is 20% of the $4500 fee -- $900. I feel the error was made by Miss H, and I am entitled to the entire discount.
I'm looking for some advice on how to approach this when the business manager calls me back next week. If she offers less than the full amount, what do I do? Is it worth pursuing in small claims court? They say they don't have documentation that I said I was a participant with Company S, but I don't have documentation that I did tell them, because it was verbal. It is my word against theirs.
Thank you!