I phoned Humana and the lady I spoke with told me they wouldn't pay anything. I told her that I still needed to file the claim because my supplementary insurer needed to see the EOB before they would pay the claim. I waited a month (the mail can be a bit slow here in the country). I assumed the claim form was not coming so I filed the claim for Mark's Parisian hospital stay with American Express Traveler's Medical Insurance along with a note that said I'd spoken with Humana and they'd indicated that they would not pay.
The response back from AmEx indicated that they absolutely had to have the EOB to process the claim. Not wanting to wait another month for a claim form that Humana wasn't actually going to mail to me, I decided to go to their website to find it.
I clicked on Medicare. Made sense, that's the plan Mark is on. The only claim form there was for pharmacy claims. Since it was Sunday afternoon, I assumed that no one would be answering the customer service phone. I opted for email. I would have an answer on Monday morning and could get the claim form completed and in the mail that afternoon.
When there was still no response by Tuesday, I opted to try their online chat feature. At least they were able to help me find the claim form. The link I had to click to get the form was "Insurance through Your Employer". Well. That's not some place I would have intuitively looked. Even though I think it's somewhat stupid to think that the only people who will ever need a claim form are people who have insurance through their employers, I didn't bother asking the customer service rep why this form couldn't be accessed from the "Medicare" tab. She didn't design the website so how would she know? It's likely that the people who did design the website don't know, either.
At any rate, I got the claim form and started filling it out. It was fine until I got to "CPT Code/Service Description" and "Diagnosis Code". I don't know what the codes are. They weren't on the bill because they don't use these codes in Europe. They may be consistent throughout the United States but they are NOT universal. I called Humana's customer service department to ask what to do. She had one mantra - "We can't process the claim without the codes".
"Where am I supposed to get these codes? Are they on the internet somewhere?"
"You need to call the doctor."
"The doctor is in France. She primarily speaks French. Their automated answering system is in French and I don't even know what number to press to reach anybody at all, much less that particular doctor. There is not a "press 2 for English" option. And since they don't use those codes, it's not likely they're going to be able to help me with that."
"We can't process the claim without the codes."
This conversation was going in a circular motion. I decided to see if Mark's local doctor's staff could help. I left a message for the person who does the billing. It's been three days and I have no response.
My next step was to call the nice folks at AmEx and see if they could give me some help with these codes. After being transferred to several different departments, the last young lady I spoke with offered to transfer me back to the department I started out with. Reluctantly, I said okay. Then she came back on the line to tell me that it would be about a 20 minute wait and asked if that was "okay". Actually, it wasn't okay. I did have other things to do yesterday. I thanked her and told her that I didn't have time to wait that long and told her I'd just make up a code and get on with it.
An internet search gave me some Diagnosis Codes. I picked the one that seemed most closely associated with the problem and wrote it in the appropriate box on the claim form. But the CPT code remained a mystery. Seems these "belong" to the American Medical Association. Operative word being "American". I'm not even sure the Canadians use them, but most certainly the French do not.
So I'm sending it on to Humana. I'm sending copies of the bills and the doctor's diagnostic report AND I'm including a letter explaining the problem. I needed to send a letter anyway just to make sure they realize the bills are in Euros. I'm guessing that the folks in the claims department are under the impression that the whole world uses US dollars.
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