CCS really needs to get some competent people working for them. On January 10th, they shipped me 3 ½ boxes of cartridges for my pump and one replacement cartridge cap. They billed my insurance company on two separate invoices. They often make billing errors and it takes them 3-4 tries to get something processed correctly. No wonder they had to file for bankruptcy. My insurance paid for the cartridge cap and my portion was $2.63. My insurance rejected the invoice for the cartridges and in the area that said “provider may bill you,” my portion was zero.
I walked over for my mail one day last week, and there was a statement from CCS. According to the statement, I owed them $113.75 for January 10th. I have not paid the prior amount because according to my insurance company, CCS owes me $500 (you can read that story here). I called CCS to ask where they got the $113.75 from. I have to pay 15% of what my insurance allows. CCS billed $262.50 for the cartridges. Even if my insurance allowed the full amount (and I know they allow $32.50 per box), the most I would have to pay is $39.38 for the cartridges and my EOB says they can’t bill anything for the cartridges.
Last summer, I got a DME statement from my insurance that included some supplies I did get from CCS but also a bunch of stuff that I did not get. I called CCS first and they said they did not bill my insurance for that. I called my insurance company and they said I had to talk to CCS. I said I did talk to CCS and they told me they did not bill that stuff. The person put me on hold and checked with the DME department and she got back on and said they have documentation from CCS that said they sent me the stuff. I then asked to get a copy of the documentation that they had because I did not receive anything. They would not give me the stuff but they did send it to CCS and it turned out that CCS billed someone else’s supplies on my account. I thought that could be part of the this problem.
The woman in CCS’s billing office decides she needs to read my benefits to me. I know what my benefits are. I also know that I have to pay 15% of the allowable amount. I want to know where they got the $113.75 and I told her I wanted the detail of what was billed. She again insists that she has to check my benefits. What does my benefits have to do with an itemization of what they billed me? I told her I wanted to talk to a supervisor. She keeps insisting that she needs to check my benefits. My question was not whether something was covered or how much my portion is. I want an itemization and I would like to talk to a supervisor. How hard is that to understand? Let’s just say I said something not very nice and I hung up on her.
I logged into my insurance so I had the 2 claims in front of me and then called my insurance. The guy pulled up the invoice for the cartridges first. They were actually labeled as “syringe with needle” and apparently, they did not know what that was. That is how CCS billed them in the summer and they were paid for then. He put me on hold and checked and said that they would re-submit that claim since it was something that I needed for my pump.
He then put me on hold and called CCS to find out what the $113.75 was. He got back on the line to inform me that CCS made a mistake. I already knew that! The claims are done electronically and CCS sees a column for “allowable amount.” The allowable amount is the price that my insurance would pay for something, not what they paid or what my portion is. Actually, the $32.50 that they paid in the past x 3.5 boxes = $113.75. The $2.63 that they were allowed to bill me was not on the statement.
I thought about sending CCS a letter to make sure it does get corrected, but I don’t want to waste the paper or a stamp. My insurance company is very good about logging stuff and they are aware of the problem so I will just wait it out. I have been waiting 8 months for them to fix the other problem, I guess I can wait a few weeks for this to get fixed also, but I do have to wonder how many other people are getting bills for the allowable amount and not what they actually owe!