Insurance companies are sucking the life out of me
I am so extremely frustrated and honestly feel defeated. I used to genuinely love my job, but insurance companies are sucking the life out of me.
I have 5 surgical cases where I worked incredibly hard to obtain both GAP exceptions and single case agreements BEFORE surgery. Everything was approved and negotiated in advance.
Then I bill the claims with the authorization numbers attached… and every single one gets processed under MultiPlan rates instead. Completely ignoring the GAP and SCA agreements.
So I disputed the claims through Availity. Of course, Availity categorizes them as “reconsiderations.” I submitted copies of the authorizations and signed SCAs for all 5 cases back in March. Since then, they have all just sat there in “processing” status for months.
Today they finally updated to “finalized.” No notes. No letters. No explanation. Nothing.
I call Aetna and the representative tells me there are “no notes” on the cases, but somehow they were supposedly finalized back in March. Meanwhile, Availity clearly shows the status updated TODAY (5/8).
Then I’m told I only have 60 days from the date “they made their decision” to appeal. What decision?! There are no notes, no determination letter, no communication, and no visible outcome attached to these reconsiderations.
Even the representative agreed it felt intentional and admitted it made no sense that cases would be closed without explanation or provider notification.
At this point it honestly feels like they delay these cases on purpose so providers lose their appeal rights and IDR rights.
I’m exhausted.