I worked for a company called dial america marketing. Dial america is a call center and has contracts with many different companies. One of their contracts is with an insurance company called xl health. Xl health has a program called care improvement plus which is a medicare advantage plan for people with certain diseases.
I was a telephone service rep who took calls from healthcare providers who would call to check claims status among other things. Care improvement plus has another company called tmg health process their claims. I took many calls day after day from unhappy providers who called to check on their claims and were rude and abusive because the claims were not getting paid in a timely manner.
Many providers told me that they would stop accepting care improvement plus because they couldnt get their claims paid. Many of these providers called numerous times and had to have their claims reprocessed over and over again. Some claims would be left in limbo because they didnt qualify to be put in the right "bucket". Other claims were taking years to get paid.
The other day, i decided to send tmg health an email asking why they are doing such a poor job processing claims. Their website boasts a 98% accuracy rate in processing a claim. Three days later they sent my supervisor at dial america that email and said i was creating problems. I was fired for not following the "chain of command". Dial america has no contact with tmg health. I wasnt making a complaint and if i was i wouldnt tell my supervisors because it would fall on deaf ears. Dial america wouldnt compromise their relationship with xl health by forwarding any complaints, questions or comments to xl health, tmg health or anyone else.
I feel i was fired in retaliation for asking a question in confidence by a company who felt threatened. There was no need for them to send that email to my supervisor because it was harmless. There was an unwritten policy at dial america where we were not allowed to give out tmg health's name to providers when they asked who processes claims. Many providers threatened to sue care improvemment plus due to these claims issues. I suppose if these providers knew who processed their claims and would gather together to file a lawsuit, it could cost all 3 companies millions of dollars. If medicaid and the government investigated it could cost them more than money.
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