Ellen (ennienyc) wrote,

It might have been easier to skip the shot and get the flu

Many phone calls later, I think I see what happened with my flu shot insurance claim.

Called UHC, who said they couldn't see the rejected flu shot claim at all. Huh? It was right there on their site. The woman did not want to listen, and switched me to Oxford.

Oxford also had no record of the flu shot claim being submitted. Duane Reade (DR) had given me a claim number earlier, which Oxford said was not valid for their system.

Called DR pharmacy, spoke to a different person from over the weekend. According to their system, the claim appears to be paid and was submitted to my insurance at the time. She advised waiting until I receive a bill, and then bring it in and they'll resubmit. She didn't want to resubmit now since it looks like it was paid, so on their end nothing needs to be done.

I was set to wait for a bill when I remembered that OptumRx HAD mentioned something about the claim when I called over the weekend. I hypothesized that DR submitted the claim to OptumRx as drugs instead of to Oxford as medical. I called OptumRx and they did have a record of it: $15.86 for the flu shot serum, rejected as "product/service not covered" (this doesn't show when I look at the OptumRx site, so must be internal. Also the amount on my rejected claim was $31.99, so someone is taking a markup). I don't know why they didn't bounce it over to Oxford (it's all the same company). I asked if they could move it over, but they said the provider had to do that. By the way, the DR claim number was not one of theirs, either.

Called Oxford and asked if THEY could retrieve the claim from OptumRx and they also said it had to come from DR. They also advised that it needed to be paid within 120 days of the service date (which will be early March), so if I wait for a bill it might be too late.

Called UHC again and used their automated system, which DID find the claim the other rep couldn't locate. I switched to a rep and asked if they could send the claim over to Oxford (again, they are all part of United), but they said they  couldn't. They also couldn't identify the DR claim number. When I clicked online on "pay this" (which I had no intention of paying, if insurance covers it), a form came up for paying a central Walgreens (who own DR) site.

I called the phone number on the Walgreens form. They said the claim had indeed been sent to OptumRx and after it was rejected, it went to my major medical. Except by the time they did this, my insurance had changed and it went to my current UHC number, which then rejected it because the plan wasn't effective on the date of service. I'm not sure if they got the wrong insurance info from OptumRx or from their own system. I did have an earlier problem with drug claims and effective dates and perhaps my old Oxford member number was no longer in the system (or maybe the dates are still screwed up). I gave them the Oxford info, they entered it... and that system was down! They will try later, and HOPEFULLY it will finally go through, and the pending amount on UHC will be deleted. I asked why my local DR thought the claim was paid, and they said it might appear that way to the front end of the system, but it was still pending to them on the back end.

So maybe we have some resolution. But I wonder, in all the thousands of flu shots, did DR mistakenly send them all through drug insurance instead of medical, or just mine? And why is it so hard to tell what my coverage was for the applicable dates? So much hassle!

UPDATE: Walgreens Central called back, and the claim still isn't going through. They will call Oxford. Crazy! I would wait until this is resolved to update this blog, but who knows when that will be?
Tags: health insurance

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