Doctor Or Insurance Company: Who Is Responsible For My Gift Card?

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Dear Pastor D.M.,

Happy New Year to you and The Essential Church! I’m writing to you because of a problematic situation that I hope you can sort out for me. If you don’t have a solution, I’m open to your advice and wisdom on how to proceed in this situation.

I am a member of an insurance company that I have grown to love over the years. As of last year, I was made aware of what the insurance company calls a gift card rewards program that all members can take advantage of and participate in, free of charge.

I was told that, upon the completion of set health activities, such as getting my flu shot, yearly physical, mammogram, and so on, I could earn enough points to qualify for a free gift card the insurance company would send to me. Since this is fairly a new program, I’ve been told, it’s not a surprise that I didn’t know about it until now.

But, there’s a problem. At the end of 2021, my doctor submitted my health information regarding the various health activities I completed that would qualify me for the free gift card. After completing my health activity that was supposed to give me the necessary points for gift card redemption, the doctor submitted the form with the wrong medical code on it. I ended up with 10 points under the necessary amount to qualify for the free gift card, however.

Well, the doctor’s office tried to rectify the situation by re-submitting the paperwork with the correct medical code and all. The insurance company says they never received it. I’ve filed a complaint regarding the free gift card. I’ve called the insurance company 12 times to talk to them about it; each time, I’m told the same thing from the insurance reps: that is, that I’ve filed a complaint and that it will take some weeks before that complaint is given a final decision. After the decision, I can appeal the case in writing if I should so desire.

I ranted at the last few because I’m tired of being told the same thing over and over again. Isn’t anyone listening to me?

I don’t wanna continue to file a case and press for one against a free gift card. It’s 2022 and I still haven’t been able to redeem my points from 2021. What can I do? What would you advise me to do in this case?

I am at my wit’s end on this and it is in this exhaustion that I seek your help. I just wanna give up on pursuing the matter at all because it seems I’m getting the run-around.

Thanks for all your help in advance, a concerned reader

don’t blame the insurance reps

Dear Concerned Reader,

Happy New Year to you and your family as well! We’re honored that you would contact us here at The Essential Church for help regarding this matter.

First off, let me say that I’m sorry that you haven’t been able to redeem your points from last year for a gift card. I know how much gift cards mean to us all in the holiday season.

But first, let me say this, in a spirit of wisdom: please do not blame the insurance reps. They are in place to do the job they are hired to do. They cannot just say and do anything because to do so puts their job at risk. They could end up unemployed and without work. Employment is a blessing, and they must be good stewards of it for spiritual, financial, and alternative reasons.

If all 12 reps have told you the same exact thing, then that means the insurance reps are doing their job. If they weren’t, their jobs would have all been terminated by now. Insurance companies don’t like it when they’re not fairly represented. The same can be said for clients who have incompetent lawyers.

the insurance company is not lying about the paperwork

Next, I think it can also be said with a fair amount of certainty that the insurance company isn’t lying to you about the paperwork. They didn’t receive it because, if they had, your points would’ve been added to the existing amount you had. After all, the insurance company received your first set of paperwork with the wrong medical code, right? If they did, then it means that they’re not deceiving you about the paperwork. They didn’t receive it.

How could they receive the first set of paperwork but not the second set, you may ask? Turns out it happens all the time. Paperwork gets lost in fax machines and the mail as do a lot of other things. Emails get lost on the internet. Paperwork gets lost in mail. It’s not hard to understand that things get lost and just don’t turn up.

And when sent via US mail, sometimes it takes weeks for mail to get where it was meant to go weeks earlier. And in light of COVID, the USPS has said that it is slowing down mail to become more efficient (their words, not mine). What does this mean? It will take even longer for mail to get where it needs to go.

So, even if the doctor resent the paperwork, it may never have gotten there. Or, here’s the alternative: maybe it got there too late, at which point your points couldn’t be redeemed and it was simply too late. Even if the latter is true, that still doesn’t mean the insurance company has to grant your points and give you a gift card.

Place the Blame Where It Belongs: On The Doctor (Primary Care Physician, or PCP)

So, you say that your doctor sent the paperwork in again to atone for the mistake on the first set. That was the doctor’s responsibility because his office failed you the first time. And yet, resending the paperwork doesn’t rectify the problem. If the paperwork was never received by the insurance company, then no amount of effort on the part of your doctor is good enough.

It’s not enough for the doctor’s office to just send in the paperwork; his office needed to call and check with the insurance company to ensure that your paperwork was received and that your points were applied. It was his fault your points weren’t redeemed earlier, so he should have been ultra-diligent about seeing to it that you get your gift card for the year.

If the doctor didn’t do that, if he didn’t follow-up, then once again, he’s guilty of having failed you as a patient. Here’s the reality: the doctor bills the insurance company for money when he sees you regularly. For every visit, the doctor submits paperwork to the insurance company about the visit so that he has documentation he actually saw you in his office. This allows the doctor to be paid for his time and service.

And trust me, when the doctor submits that paperwork to be paid, he’s going to make sure that he bills with the correct medical code because, if he doesn’t, he won’t get paid. No doctor is going to see patients and not get paid for those patient visits. So with that said, if he is so diligent in billing for your patient visits, why couldn’t he be as diligent to ensure the right medical code for your health activity so that you could get your points and free gift card?

It seems to me like the doctor was too consumed with seeing patients and billing insurance that he didn’t take the time and attention with your paperwork that you deserved. It’s unfortunate, but that’s not the insurance company’s problem. It’s not their fault. Lastly, it’s not something for which they must make restitution.

Your insurance company is not responsible for the failure of your doctor to see about you. You are “his” patient; therefore, whatever failures he accrues with regard to you are his responsibility and deserve to be laid at his feet — where the blame belongs.

Don’t wait until the end of the year to complete health activities for gift cards

Maybe it doesn’t need to be said, but I’ll say it here: don’t wait until the end of the year to complete health activities! The goal of completing health activities is to maintain some sort of knowledge about your current health to mitigate problems if they arise. That’s a reward in and of itself. When I was growing up, insurance members didn’t have rewards programs for health activities.

Back in those days, if you didn’t care enough about your health to use your insurance and check up on your own body, it was your own fault. Nowadays, companies reward members for doing something they should do simply because they care about their own lives. Gift cards and rewards programs are not bad things, but they are crutches for some. Some have to have a gift card in the balance in order to do what they should be doing all along — gift card, reward, or none at all.

With all things, diligence and vigilance are key. If you know paperwork can be lost in the mail, don’t wait until November and December to send it to your insurance company; send it in as soon as possible. Get those health activities completed as soon as possible. That way, in the event that paperwork needs to be submitted, doctors can resend paperwork with enough time to spare.

Waiting until December to send in paperwork, then getting upset because it isn’t received within the last few days of the year, doesn’t qualify as “early sending.” I would suggest sending in the paperwork no later than mid-October. In fact, if you notice your doctor hasn’t said anything about the paperwork, remind him and/or his secretary to send it in. Remember, they have to sign off on your health activities for you to receive credit for them towards your gift card. You can’t send in the paperwork for them, but you can remind them to do it.

The doctor’s failure to submit the paperwork and see to it being sent is no excuse for your failure to remind him. It takes teamwork to make the dream (or agenda) work. That includes you.

Don’t expect the gift card: conclusion

I know, I know. These things are things that maybe you know and need to be reminded of. But along with these words, I must tell you: it is unrealistic to expect that the insurance company will reward you with a gift card under these circumstances.

The paperwork could have gotten lost. It wasn’t received in time. What I do know about gift cards and rewards programs is that the points expire on the last day of the year. If a gift card isn’t secured by December 31st of the year in which the points were earned, it’s too late to redeem those 2021 points in 2022.

So with that said, the points were not redeemed last year and are no longer valid. Those points are gone and lost.

Sure, you’ve filed a complaint and have yet to hear about the decision. I’d wait to hear the final decision before counting yourself out, but with the rules being what they are, I wouldn’t expect that gift card.

There is a way to rectify the situation, though: your doctor could always give you a gift card (monetary price of your or his own choosing) for your trouble. Maybe he will be gracious and give you a gift card for double what you would have received from the insurance company. After all, it was his mistake, his coding error, his failure, that ruined your point redemption. He should feel some remorse and do more to make it right than just submit paperwork and then hold up his hands and say, “it’s no longer my problem.”

At any rate, the doctor should make it right. I’m sorry if he chooses not to, but that’s not the insurance company’s fault. You don’t hold the insurance company responsible for the failures of your doctor. You hold the doctor responsible.

The 12 company agents told you what you needed to hear, not what you wanted to hear. That’s why you’re frustrated: you were heard and understood but just didn’t get the answer from them you wanted. Again, they did their job to help you but you just weren’t listening.

At the end of the day, your doctor is to blame; neither the agents nor the insurance company should have to pay for it. If your doctor isn’t willing to go the extra mile as your medical advocate (your “primary care” physician), then why expect the agents and the insurance company to do something it is not their responsibility to do?

You’re free to wait until the decision about the gift card has been made, but again, don’t expect the gift card because they don’t have any legal or moral obligation to grant it.

Let’s just pray that your doctor learns from his mistake and doesn’t repeat it again. – Pastor D.M.

Do you have an issue you’d like to ask Pastor D.M. about? Is there some issue that you think requires an outside perspective? If so, feel free to contact Pastor D.M. here at The Essential Church by clicking on the “Contact” page and sending an email. We’d love to hear from you.