April 10, 2012

Caremore Healthplan of California

By admin

For well over a year now, we have been receiving EOBs from Caremore Healthplan of California with numerous under-payments and over-payments errors. Take for example, one check that we received: They processed 31 claims and only 4 of them were processed correctly! :O That’s an 87% margin of error on one check for one doctor!

So I took it upon myself to call the powers that be to see if they could fix their claims processing problems. After 20 minutes on hold, I was routed to their claims manager voicemail. I left an extensive message regarding payments errors. She didn’t call me back. So I called again a few days later and again was put on hold for 25 minutes. Finally, a nice lady from their claims department went to look for the claims manager and put her on the phone.

I explained the problem to her and asked if she could look into the problem and let me know when it is going to be fixed. She got belligerent and escalated in tone as she said that she is ‘looking into this’ but she can only answer to the Dr office or to me but not both. Well, did I say that this problem has been going on for well over a year now?

Now you would think, if somebody brings up a problem that might improve your operations, you would be happy to address it. Well, she was not! Sensing that I wasn’t going nowhere with her, I asked for her supervisor. She promptly transferred me to *guess what* her supervisor’s voicemail.

Well, you can only lead a horse to water… I’ve been in this business long enough to see many managed care companies with this kind of ineptitude have all gone belly up. You can’t lose thousands of dollars due to a poorly constructed system, ignorant staff, and stay in business. So providers watch out and don’t put all your eggs in one basket with Couldn’t CareLess Health Plan of CA!

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