If you have questions about the practices of your managed-care coverage, ask the experts at the state Department of Managed Health Care. They take up issues ranging from difficulties getting an appointment to denial of a doctor's recommendation for treatment.
I wrote no fewer than six letters to my elderly father's insurance company before its representatives would even talk with me. I have no idea how seniors deal with companies like this one.
For some reason, my father's medical bills have been getting denied by his health plan on the basis that he is an "ineligible member." I was eventually able to speak with several health plan employees who said this was a computer error and could be corrected. Yet the bills continue to be rejected.
– Ronald Javor, Sacramento
The disagreement with your dad's insurer appears to stem from the time when your father's coverage changed and he was given a new identification number.
According to the records we reviewed, the physicians treating your father were submitting their bills to the health plan using the old identification number.
When the health plan's computer system tried to process these claims, it showed that member number was no longer valid.
After we identified the problem, your father's health plan manually reprocessed each denied claim and then adjusted the system to prevent future claims submitted under the old identification number from being denied automatically.
However, you may also want to let your physician know that your father's identification number has changed.
Your situation is a good example of an issue that may not involve direct medical care but can still cause a consumer anxiety and a feeling of "getting the run-around."
If you have any issue that you can't seem to work out with your health plan, be sure to call the Department of Managed Health Care. We will do our best to help.
To ask a question, go to www.sacbee.com/ask or write Second Opinion; Features Department; The Sacramento Bee, P.O. Box 15779, Sacramento, CA 95852.
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