Tuesday, July 10, 2012

Rawlings Company -- What Have I Done to Upset You? (Updated3)

Intro2 9/19/2012:
Rawlings Company/Group (I'm still not sure which name you 'officially' go by) -- I've noticed you have found this blog entry speaking of my frustrations with your company.

As comical as my exposition reads, please understand this was the tragic truth about how The Rawlings Group treated me in this matter.

I tried to talk to you directly. In writing and both via email and snail mail. Never got squat until the very end of the adventure when I got back only this short email:
From: Shane [MASKED] <[MASKED]@rawlingscompany.com>
Date: Tue, Jul 10, 2012 at 2:36 PM
Subject: RE: Regarding Continual Requests for Information Concerning References 55199225 and 53524865
To: "christoperj"

Both files are now closed. Thanks for the information

Shane [MASKED]
Subrogation Analyst
The Rawlings Company
Ph: [MASKED]
Fax: [MASKED]

And even that was only when both myself and my auto insurance company sent our last responses via email, fax, and US Mail to make sure they were 'received'.

Wasn't even an apology for the confusion or hassle or whatever it was. In fact, I never received any explanation concerning why my answers to your questions were being 'lost' or 'ignored' or 'dropped by the internal Rawlings Group processes' or whatever happened. And on the fourth letter when your treatment date suddenly changed to reflect a time when there was no ER visit -- and I clearly asked for more information about what you were talking about -- I got no response on that either.

I recognize this might have been a individual situation. A bad individual situation. But maybe an individual one none the less. But this is what happened.

If you would like to speak with me directly from a 'process improvement' perspective to help figure out where it went wrong so it doesn't happen again. Just shoot me an email and we can talk further.

Otherwise, no worries or hard feelings.


Intro 9/6/2012:
I gather the Rawlings Group is harassing (er, making polite professional inquiries to) a new set of insurance customers, based on the sudden uptick of hits to this page.

Good luck and godspeed. Very much hope you have better luck than I did.


Original Post:
(What should I call you? The Rawlings Company or The Rawlings Group? I've seen both, and I'm not sure which name you go by.)

All I did was to file an ER claim against my health insurance for treatment after an accident. It was just that, an accident. Nothing intentional. Nothing personal. Just is what it is.

So why do you keep bugging (harassing) me about it?

Now I do admit -- I ignored your first written letter looking for information about the accident so you could recoup costs from whoever was responsible. Again not personal! The letter just looked like a scam. Sure you said you representing my health insurance company in the matter. But the fact is, I had never heard of you. And I could send you an email that claims I'm from Citibank (or any company) and that just doesn't make it true. So alas, I did not respond. I always intended to dig into it further, but life got in the way. My fault for not responding. I fully admit it and I apologize again (and again) for my careless actions.

But when the second letter came in March, along with a vague threat that our lack of response would somehow impact my company's health coverage, I quickly responded! Doesn't that make up for it? I submitted everything via the Rawlings Online Claim Information website. I explained that the accident was what it was, and was our fault. There were no other claims submitted with anybody. There was nobody else to sue. It was what it was.

So when May 19th rolled around and we recieved two contradicting letters on the same day -- one "thanking me for returning the claims information", and the second asking me to "complete the questionnaire" the first letter acknowledged I already sent -- I was left wondering "what the crap"?
Letter 1:
CHRISTOPHER MARCINKO
[MASKED]
DENTON, TX [MASKED]

Re: Our Client: Aetna Health Plans
Member/Patient: CHRISTOPHER MARCINKO/CHRISTOPHER MARCINKO
Our Reference No.: 55199225
Date of Treatment: 10/21/2011
Treatment By:

Dear CHRISTOPHER MARCINKO:

Thank you for returning the claims information form recently forwarded on behalf of your health plan. The information received received indicates that you were involved in an accident causing your injuries. We understand that you may be making a claim against another party or insurance company, but additional claim information is needed to complete our review process.

Our client has a claim for medical benefits paid on behalf of the patient for the loss referenced above. Under such circumstances, the health plan's claim is to be paid from any settlement or payment you may obtain from either another party or your own insurance company. Therefore, please make sufficient allowances to satisfy the health plan's claim in any settlement you receive. If you do not, the rights of your health plan may be compromised.

Please call me your earliest convenience at the number listed below. If I am unavailable, please leave a message indicating the best time to reach you.

Thank you for your cooperation.

Sincerely,
Shane [MASKED]
Recovery Analyst
[MASKED]
[MASKED]
[MASKED]
[MASKED]@rawlingscompany.com

Letter 2:
CHRISTOPHER MARCINKO
[MASKED]
DENTON, TX [MASKED]

Re: Our Client: Aetna Health Plans
Member/Patient: CHRISTOPHER MARCINKO/CHRISTOPHER MARCINKO
Our Reference No.: 55199225
Date of Treatment: 10/21/2011
Treatment By:

Dear CHRISTOPHER MARCINKO:

The Rawlings Company is working with your health plan's cost savings program. We are reviewing claims to determine if they are related to an accident or injury where another person, organization or insurer may be responsible to pay claims.

Please complete the questionnaire located on the reverse side of this letter to assist us in this claims review process. Please complete the form, even if you have already supplied this information to your health plan directly. We have enclosed a return envelope for your convenience.

If you need assistance to complete the form, please contact me at the number listed below. Thank you for your continued cooperation in our efforts to keep the cost of your health benefits at the lowest level possible.

Sincerely,
Shane [MASKED]
Recovery Analyst
[MASKED]
[MASKED]
[MASKED]
[MASKED]@rawlingscompany.com

Clearly I have somehow offended you, or your website lost our Claim Information where I clearly stated the accident was completely our fault. I tried to resubmit, but the site blocked me from resubmitting any information.
Error when I try to resubmit the information online:
"We cannot proceed! Please call the toll-free number listed on your letter to speak directly with a representative with the Rawlings Group if you have additional information you wish to add to your questionnaire."

If you already have my infrormation, why the crap do you keep asking me the same question?
Error when I try to resubmit the information online:

We cannot proceed! Please call the toll-free number listed on your letter to speak directly with a representative with the Rawlings Group if you have additional information you wish to add to your questionnaire.

I quickly filled out your form in writing and sent it off via US Mail to the address in the letter. Also included a letter of my own summarizing everything that I put in the form. Basically (again), it was an accident, and was our fault. There were no other claims submitted with anybody. There was nobody else to sue. It was what it was.

And then the fourth letter came on June 13th.
CHRISTOPHER MARCINKO
[MASKED]
DENTON, TX [MASKED]

Re: Our Client: Aetna Health Plans
Member/Patient: CHRISTOPHER MARCINKO/CHRISTOPHER MARCINKO
Our Reference No.: 55199225
Date of Treatment: 6/24/2011
Treatment By:

Dear CHRISTOPHER MARCINKO:

We recently sent you a questionnaire on behalf of your health plan. To date, we have not received your response.

We are working with Aetna Health Plans to obtain information concerning claims that may be related to an accident, and therefore might be the responsibility of another insurer, person, or organization. This information helps Aetna Health Plans in keeping the cost of your health plan at the lowest level possible.

Again, we ask that you please cooperate with your health plan by completing the questionnaire on the reverse side of this letter. A return envelope is enclosed for your convenience.

If you need assistance in completing the form or if you have any questions regarding this matter, please call me at the number listed below.

Sincerely,
Shane [MASKED]
Recovery Analyst
[MASKED]
[MASKED]
[MASKED]
[MASKED]@rawlingscompany.com

Sigh. Seriously? Are you expecting that I'll change my answers if you keep asking the same questions over and over and over and over? This latest letter didn't include a vague threat about impacting my company's health insurance, so I guess that was a plus. At least you were more cordial this time around. But still not listening to me. Sigh.

And weirdly -- your claim information changed. Now you're asking about an ER visit on June 24th, 2011. This claim date apparently changed in your May letters, but I had missed it then. But whatever the case, I caught it this time. And while I admit I can barely remember last week, I am all but positive I had no ER visit on that date. So I responded --
June 16, 2012
The Rawlings Company LLC
ATIN: Shane [MASKED]
P.O. Box 40031
LaGrange, Kentucky 40031-8100

RE: Continual Requests for Information Concerning References 55199225 and 53524865

Mr. [MASKED],

Both my Wife and Myself have received multiple letters from you and your office over the last year concerning an Aetna Healthcare Claim pertaining to treatment received on June 24th, 2011.

We have actually sent you information concerning what we thought was the incident you were referring to (an incident for which we were completely at fault). That information was submitted first online in response to your second request, and then in writing in response to your third request.

However, a closer look at this latest (fourth) request is giving us pause as it refers to a June 24th, 2011 treatment date. We have no record of any treatment on this date.

Please send us further information about the treatment claim for which you are referencing and we will validate with our own records and respond accordingly.

Thank you,

Christopher J. Marcinko

And then just silence. You didn't respond with any additional information about the incident you're trying to investigate. Nothing. Nada. Zilch.

Instead -- you decided to go after my auto insurance company and tried to claim (scam) them out of the bill! Um, what?
Ms. Karen [MASKED]
[MASKED] Insurance Company
PO Box [MASKED]
[MASKED]

Re: Our Client: Aetna Health Plans
Member/Patient: CHRISTOPHER MARCINKO
Date of Loss: 6/24/2011
Our Reference No.: 53524865
Your Client:
Your Number: [MASKED]
Claim Amount: $2,779.70

REQUEST FOR PAYMENT OF MEDICAL PAYMENT/PIP BENEFITS

Dear Ms. [MASKED]:

Our client, Aetna Health Plans, has retained The Rawlings Company, LLC, to obtain recovery on behalf of the patient [MASKED]'s health plan in connection with the accident that occurred on 6/24/2011. According to our investigation, the health plan paid medical benefits on behalf of the patient. It is our understanding that the patient is eligible for medical payments/PIP benefits under your policy of insurance. Therefore, we request payment under your policy for the payments made by our client.

The patient is covered under a medical benefits plan that provides the health plan with a right of subrogation. This general means that by participating in the medical benefits plan, the patient agrees that the health plan has the right to pursue and receive any amounts the patient is entitled to receive from another as a result of the accident. In other words, the health plan may maintain the same right to payment from your policy of insurance as the patient. Compensating the health plan in such circumstances is in accordance with your policy of insurance and the patient's agreement with the health plan.

The enclosed itemization includes the diagnosis and/or procedures codes necessary for reimbursement. As you are aware, many facilities and provider offices now file their claims electronically. As a result, there may be no paper claim available. Should you require bill copies, medical reports, or other documentation, please contact the providers directly. Please make your check payable to:

The Rawlings Company
ATTN: Shane [MASKED]
File No.: 12AS10502710
PO BOX 2000
LaGrange, KY 40031-2000


If you are unable to comply with this request, please respond in writing and provide the reason for the denial. If benefits have been paid or exhausted, please forward a copy of your payment log so we may review possible duplicate payments.

Sincerely,
Shane [MASKED]
Recovery Analyst
[MASKED]
[MASKED]
[MASKED]
[MASKED]@rawlingscompany.com

Lets set aside for a moment the (questionable) ethics of searching me out via an insurance database in lieu of listening/accepting the information I have already provided multiple times over. But the accident you tried to 'claim' was clearly listed a minor rear ending which originally occurred 4 months before the ER visit for which you're trying to recoup costs.

Do you really believe I would have waited 4 months to visit an ER for injuries related to a car accident? Seriously, who does that?

And regardless -- that accident database also indicated it was the other guy's fault. My insurance company wouldn't be liable anyway.

Whatever the case, this thing you're trying to bill everybody else for was (again) simply an accident. And a non-automobile one at that. And was our fault. There were no other claims submitted with anybody. There was nobody else to sue. It was what it was. My insurance company quickly told you as such this afternoon.
July 10, 2012

The Rawlings Company LLC
PO Box 2000
La Grange, KY 40031-2000

File Number: 60000944204
Date of Loss: 06/24/2011
Patient Account Number(s): Reference No. 53524865/ File No. 12
Dates of Service: October 22, 2011

To Whom This May Concern:

We are in receipt of bills for the above individual for the treatment date listed above.

The treatment received on October 22, 2011 was for injuries resulting from a fall suffered that day. It is our understanding that this incident did not involved an at fault third party.

The treatment received is not related to the automobile accident on June 24, 2011. Therefore, we must deny payment for your claim in the amount of $2,779.70.

If you have any questions, please feel free to contact me.

Very truly yours,

Maria [MASKED]
Claims Department

And since there is clearly a communication issue on the matter, my insurance company sent this to you in 3 different forms

1) By Fax
2) By Email
3) By USPS Mail

And I also followed up their claim denial with my own letter restating the same information and (hopefully) clearing any confusion
July 10, 2012
The Rawlings Company LLC
ATTN: Shane [MASKED]
P.O. Box 40031
LaGrange, Kentucky 40031-8100

***VIA FAX, EMAIL AND USPS MAIL***

RE: Continual Requests for Information Concerning References 55199225 and 53524865

Mr. [MASKED],

Please forgive how I am sending this to you via three mediums. Previous communications appear to be either not reaching you or at the very least are going unacknowledged. As a result, my answers to your questions appear to have gone ignored. And I have not received any information pertaining to my request for additional information I sent on June 24th.

Both my Wife and Myself have received multiple letters from you and your office over the last year concerning an Aetna Healthcare Claim pertaining to treatment received on June 24th, 2011.

The last letter was dated June 13th, 2012. We responded (in writing) on June 16th asking for further information as it referred to a June 24th, 2011 treatment date for which we had no record of any treatment. (See Attached)

To date, we have received no additional information from your company. However, I received a call from [MASKED] Mutual Insurance concerning a demand for payment you have sent them.

This latest action further perplexes us.

We have actually sent you information concerning (several times) what we thought was the incident you were referring to (an incident for which we were completely at fault). Further, while this incident was not covered by any of my unrelated [MASKED] Mutual Insurance policies – we were covered by the Aetna Health Insurance policy which was provided at the time of treatment. It is my understanding that your company is somehow working on their behalf.

Whatever the case, the information about the incident was submitted first online in response to your second request, and then in writing (and sent via USPS) in response to your third request.

I did not receive any response to my June 16th letter. However, I have been able to infer from the information you provided [MASKED] that your records are only partially correct.

1) On October 22nd, 2011, we visited the ER to treat injuries resulting from a fall suffered earlier that afternoon. This incident (as we have repeatedly said) was our own fault and did not involve an at fault third party.

2) The June 24th, 2011 incident you referred to in your previous letter (and to [MASKED]) was an unrelated low speed rear-end accident which occurred four months prior to the ER visit in question. They are completely unrelated.

With your records errors corrected and the ensuing confusion now cleared, we have provided you all available information on this situation.

Thank you,
Christopher J. Marcinko

CC: [MASKED] Mutual Insurance, File# 60000944204

And just like my insurance company -- I have also sent it via mail, fax and USPS in a hope that it is received/processed by whoever needs to see it.

So hopefully that will be it.

Because seriously, what else do you want from me?

I tried telling you this was an accident and no one else was at fault. You responded by ignoring my statements and asking for the same information again (while also vaguely threatening how if I did not respond my company's healthcare could be jeopardized.)

I tried telling you a second time that this was an accident and no one else was at fault. You responded by ignoring my statements again, and sending a more cordial letter asking for the same information.

As this last written request listed a weird treatment date for which I had no information -- I requested additional information about what you were talking about. You responded with silence and instead tried to go after my auto insurance company claiming it was related to a clearly unrelated accident four months prior.

No matter how many times you ask the question. The answer will stay the same. The accident was our fault. There was nobody else to blame but ourselves.

Repeating the question over and over in hopes of getting an answer which will allow you to sue the snot out of somebody else isn't going to work. There simply is nobody else at fault but us.

And good luck trying to convince my auto insurance company that it a minor not-at-fault accident from 4 months prior has anything to do with this. You guys may not be listening to me -- but they are. And they're not paying you a dime over this.

Whether you finally listen or not, is obviously another question.

Update 7/10/2012 @ 2:36P:
Just received a short (and somewhat unfulfilling) confirmation from Shane that the matter is now closed. Huzzah!
From: Shane [MASKED] <[MASKED]@rawlingscompany.com>
Date: Tue, Jul 10, 2012 at 2:36 PM
Subject: RE: Regarding Continual Requests for Information Concerning References 55199225 and 53524865
To: "christoperj"


Both files are now closed. Thanks for the information

Shane [MASKED]
Subrogation Analyst
The Rawlings Company
Ph: [MASKED]
Fax: [MASKED]

Sure, an explanation on their behavior would have been nice. And an apology is definitely warranted.

But at least it's all closed and I can get back to far more important things in life.


Update2 9/18/2012:
Added screenshot from the Rawlings Online Claim Information website error I received when I tried to resubmit my answers after receiving the third letter.


Update3 10/2/2012:
Found the third set of letters when digging through the desk drawer for something unrelated. These have been added to the narrative and some related minor timeline details have been corrected.