Elias Lampiris sent a message to Kenneth Burdick that said:
Dear Mr. Burdick,
I am a recent customer of your Medicare Advantage Plan in Georgia. First, I need to apologize for bringing the following problem to your attention but the lack of communication and transparency of the Wellcare Customer Service and Reimbursement Division requires I do so. Here in outline is the problem:
I faxed two claims to the reimbursement group on 3/2/2020. I received no acknowledgement. I contacted customer service on 4/20/2020 and was told they didn't have the claim or they were looking for it- the explanation was confusing. I received no follow up call.
Today, 5/5/2020 I called again to inquire about the status of my claim. The first person I spoke to said there was no claim on file (in fact, no claim appears on my webpage). I asked to speak to a supervisor and after about 20 minutes was connected to the Billing Department, not a supervisor. After another period of time, it was clear I was in the wrong place. I ended the call and called the customer service line again.
I spoke to a very nice service representative who connected me to a supervisor who, after about 10 minutes informed me that my case had been closed. She expressed surprise when I told her no one had called me to tell me that. When I asked about the resolution of my claim she then researched further. Anna told me that the reimbursement department indeed had my claim and were to review it per their policy of 60 days to perform a review. When I asked what date began the 60 day review I was told 4/20/2020 not 3/2/2020 when I submitted the claim.
I then asked to speak to the supervisor if the reimbursement department. Couldn't do that because there is no phone line to that person. Then I asked to speak to the executive in charge of operations. Couldn't do that either. The organization is opaque and disconnected from your customers.
My request is is simple. I want my claims expedited to be in accordance with the reimbursement department's policy. Sixty days from 3/2/2020 is 5/1/2020. Please light a fire under the people responsible for the review and make them live by their policies. I find it unacceptable that a breakdown in their process means I must wait longer (60 days in itself is generous since normal claims seem to be handled in 30).
Again, I apologize for bringing this to your attention but the insulation of your colleagues in charge of operations requires me to do so.
Respectfully.
Elias Lampiris
P.S. When I asked your customer service representative for your name, she said she didn't have that information.
