BP
Belinda P
1 reviews | Active since Mar 2015
06 Jan 2022, 09:42
Claim rejected 4 times
I submitted a claim for a refund on 23 December 2021. For the last 2 weeks I have been going back and forth with the claims department because the claim was rejected 4 times now. The last one was rejected because the ICD10 codes are invalid. What the hell do I know as the patient what ICD10 codes are valid? The call centre agents just keep escalating this matter but no ****** resolution. Gems is fine taking your monthly contributions but this is the type of hassles you get when claiming. On top of everything else the call centre agent tells me it will take 7 working days to get an outcome. Really another 7 working days to resolve this?
Helpful (0)
Replies (1)0
Replies (1)BP
Belinda P's updateReviewer Update
12 Jan 2022, 09:13Good Day
Now the claim was processed but a hold has been put on the payment. *** is going on. Call centre agent tells me now the practice number of the doctor is different on the account to the one on the system and it will be escalated again for clinical review (have to wait another 48 hours to get a response). How many times must a claim be escalated? I am so sick and tired of this call centre. When I ask to speak to someone senior who can sort out this ****** claim I get told they are not available? No response from the complaints liaison officers except the standard replies.
Now the claim was processed but a hold has been put on the payment. *** is going on. Call centre agent tells me now the practice number of the doctor is different on the account to the one on the system and it will be escalated again for clinical review (have to wait another 48 hours to get a response). How many times must a claim be escalated? I am so sick and tired of this call centre. When I ask to speak to someone senior who can sort out this ****** claim I get told they are not available? No response from the complaints liaison officers except the standard replies.
BP
Belinda P's update12 Jan 2022, 09:13
Reviewer Update
Good Day
Now the claim was processed but a hold has been put on the payment. *** is going on. Call centre agent tells me now the practice number of the doctor is different on the account to the one on the system and it will be escalated again for clinical review (have to wait another 48 hours to get a response). How many times must a claim be escalated? I am so sick and tired of this call centre. When I ask to speak to someone senior who can sort out this ****** claim I get told they are not available? No response from the complaints liaison officers except the standard replies.
Now the claim was processed but a hold has been put on the payment. *** is going on. Call centre agent tells me now the practice number of the doctor is different on the account to the one on the system and it will be escalated again for clinical review (have to wait another 48 hours to get a response). How many times must a claim be escalated? I am so sick and tired of this call centre. When I ask to speak to someone senior who can sort out this ****** claim I get told they are not available? No response from the complaints liaison officers except the standard replies.