My mother is 90 years old, hard of hearing, and looses somewhat in the translation. She bought a hearing aid for over #3,000. Her provider did not a file claim. She had to file herself. After requesting her claim form twice from Health Net' she filed to the best of her ability. The claim was denied (without a written notice) four months from the date of service for "timely filing". Even if she knew the Health Net rules, she is a MEDICARE recipient and has 12 months to file a claim (per Medicare's contract with Health Net). However, this claim has been denied x 4 (I, her 60 year old daughter, have been following up and have had this claim sent for reprocessing since I found out about it in February when I went home for my sister's funeral). This has been a nightmare. I called again today, June 1st in followup only to be told it was denied again and resubmitted again with another note about Medicare and timely filing rules. I was told it will take another 45 days. I then called the Medicare Ombudsman to get them involved (it will take them 2 days to get back to me), so I decided to write you. Health Net member services tells me they do not process the claims, only send then to claims processing and can not talk to claims processing. I was even told that they do not have the phone # to processing-I offered to give it to them. Basically I was told that one hand could not talk to the other hand. I was so frustrated. I worked in medical billing for over twenty years. If I felt helpless, how do you expect the majority of our insurance uneducated senior population to fight for what is rightfully theirs. My mother should be reimbursed her allowable payment plus interest for 6 months of untimely payment. Health Net needs to educate their employees and change their rules and let they departments work together for the welfare of their patients. Please help!
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