Palmetto GBA: I want to stab them in the face

Added January 2013: I just read a September 2012 article stating that Palmetto GBA has lost the contract for Medicare, which will be reinstating Noridian.   I don’t have great memories of Noridian either & am not totally excited about another transitional period, but maybe things will get better.

For the multitudes of Medicare billing personnel that read my blog.   lol

This is the letter I sent to Palmetto GBA with a claim today.   Yes, we still submit paper claims.   Our practice is too small to switch to EDI.   And besides.   This computer sucks.

Wednesday, April 22, 2009

Dear Palmetto GBA Claims Processing Department,

The attached claim has been denied twice for completely false reasons.   We have been struggling with Palmetto for a year trying to accomplish what should be a simple transaction.   It’s a known fact that claims get denied for the merest of technicalities dependent upon the processor’s whim, but in the case of this particular claim the denials are happening for technicalities that don’t even exist.

There is currently a very healthy discussion of Palmetto GBA’s inadequacies at this article: http://www.familydocs.org/news-media/news/palmetto-gba-taking-over-nhic-medicare-claims.php#comment-3211

The several pages of comments contain complaints that all have a common thread about your company.   Inaccurate claims processing, ignorant claims handling, “surly” provider service representatives.

If you continue to treat providers this way you will leave us no choice but to go to other parties in an attempt to get done what needs to be done.   It is your job to process Medicare claims.   It is not your job to obstruct the processing of Medicare claims by making numerous errors.   Already several addresses for complaints against Palmetto GBA have been mentioned in the comments section of the abovementioned article & it is obstruction like what you are doing with the attached claim that will cause me to use those addresses.

If this claim is denied one more time for bogus reasons I will be submitting all notes & correspondence to every complaint recipient I can find.   I’m tired of this & I don’t have time for this kind of nonsense.   Neither do you.

FUCK YOU PALMETTO GBA.

(that last part wasn’t in the letter.)

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5 responses to “Palmetto GBA: I want to stab them in the face

  1. IT IS AMAZING THIS MEDICARE CONTRACTING COMPANY, PALMETTO GBA, WHICH IS OWNED BY BLUE CROSS/BLUE SHIELD, ACTUALLY WON THIS CONTRACT! THEY GOT ALL OF MY INFORMATION WRONG AND THE PROVIDER ENROLLMENT NUMBER AT 866-895-1520 WILL NOT GO THROUGH AFTER BEING ON THE PHONE FOR 25 MINUTES!
    AND THE GOVERNMENT ACTUALLY WANTS TO TAKE OVER OUR HEALTHCARE!!!

    GET RID OF THE LOWEST BOTTOM FEEDER BIDDER AND PAY A COMPANY WELL ENOUGH TO BE MOTIVATED TO DO THEIR JOB!!!

    • I hear you. What’s crazy is, even my state Insurance Commission office can’t tell me where I can file a grievance. When I asked for it, they gave me… Palmetto’s number.

      At this time I’m dealing with a claim that has been resubmitted 3x. They’ve found a different reason to deny it each time, every reason not making any sense or being outright BS — like saying Box ## needs to be filled, when it was clearly filled. So I fill it again & resubmit, & then they come up with something else equally ridiculous. It really IS astounding how bad this company is, although I will admit they’re better than they were when they began. Isn’t that scary?

      • Hello. Did you ever figure out a way to file a complaint against this company? I am desperate to figure out how to do this.

        • Jessica,
          I am currently in the same boat I believe. I am waiting on claims to be paid from over a year ago. Multiple errors and now they are requesting all the paper work. I switched my office a month or two ago and they denied claims again because I didn’t switch my address change with them. Apparently Medicare isn’t an umbrella. Anything You get or response please do so to me as well.

        • No, I did not. We suffered hundreds of dollars in payments that were owed us completely due to claims just disappearing into the Palmetto black hole of incompetence.

          The situation improved & Palmetto stopped making these incredible errors after a few months, but claims expired (you can continue to re-submit as year after the date on the most current EOB… but if they simply never send you an EOB, then you’re fucked) & we didn’t get paid. I’m under the impression that Palmetto hired a bunch of noobs when they got the contract, & it simply took a few months to train them.

          Everything went smoothly until 2015, when Medicare claim processing was moved back to Noridian. Noridian required us to re-enroll completely – as if we were just starting a brand new practice. In the meantime, we were still seeing patients & these claims had to be re-submitted over & over & over again. Noridian wanted a brand new NPI number. We got one, & then Noridian rejected our claims because of the new NPI number that they had JUST REQUIRED US TO GET. And then we had to re-enroll AGAIN. It took months to get paid.

          Between Obamacare & Noridian, Dr decided it was time to retire. Our office closed on December 31, 2015.

          It is now October 2016 & we are STILL WAITING for thousands of dollars in claims which were submitted in February 2016. Since the office was closing, Dr. filed a Change of Address with the post office. A Change of Address, apparently, is an automatic Cancel Payment for Noridian. Even though all claims were approved & processed, they refused to send us the check. And they required us to – you guessed it – RE-FUCKING-ENROLL.

          I jumped through all their hoops & was told I had jumped successfully, & that we could expect a payment in 180+ days.

          So… fuck you, Noridian.

          I’m sorry if you are getting fucked by them as well. I sympathize. But they are federal & they are basically untouchable in court. All you can do is be persistent & keep re-submitting, making phone calls, & re-submitting again.

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