I was injured on 12/27/08 and discovered a week later that my policy with Mega included a $1500, accident policy. I had to pay for the clinic visit at the ski hill to the tune of $608 before I could leave. I started checking with the clinic a month later trying to track down my payment from the insurance company.
Apparently the clinic didn't file the paperwork until Feb. 5, 2009. The doctor's office filed their claim the day after my visit and received payment within a couple of weeks. I received a letter from Mega stating that they paid the clinic directly...even though the claim stated that the clinic had a zero balance. When I filled out the paperwork I must have checked the box that said pay the provider. No one at Mega thought to wonder why they were paying a claim with a zero balance?
In the meantime, I was given a prescription from the doctor for a functional knee brace, got all of the diagnosis codes and product billing codes so that I could purchase the brace online for $630, rather than buy the same brace through a 3rd party for $1200. That paperwork was filed with Mega as 'pending' and I was told it would take a month to process the claim. Why? They paid the doctor and the clinic within a couple of weeks. Why then if I file a claim myself must I wait a month? I called again today, since it's been over a month since I filed the claim and discovered that they did not receive all the information that they needed. Everything they needed was mailed to them. She requested that I send the paperwork via fax and that it would be another month to process!!! What? They lost the paperwork and it will take a month to correct their error?
They take their premium every month from my checking account yet when it comes time to pay for an injury...they will pay everyone but the patient!