OT: Insurance/medical billing help

[Momof3Labs]

I am sooo frustrated that this should probably go on the bitching post. But since I'm looking for advice, I'll post it here instead.

The way my insurance is set up, it should cover Logan's IVF cycle 100% (yep, we're still dealing with charges for the conception of a child who is 2.5 weeks old...). The dr's office, however, has not submitted it using the correct codes (they keep on trying to submit it using a bundled code under a contract that my insurance company said does not apply to my plan), so they have not been reimbursed 100% by the insurance company. Now, they just submitted it using more incorrect information to DH's insurance (my secondary) and, not surprisingly, didn't get any money out of them.

I know that somewhere along the way, I probably signed something saying that I would pay any of the charges that our insurance does not pay. But the only reason that our insurance isn't paying is because the dr's office won't submit the charges properly!!

My plan is to call and *try* to talk to a supervisor at the dr's office tomorrow (big corporate type office, so should be *fun*).

Does anyone else have any other suggestions? We can't dispute the claim with the insurance company since they paid based on what was submitted to them. Is there any way to compel the dr's office to submit the claim properly??

TIA!!

[Wife_and_mommy]

From my understanding this is what happened with dd's delivery so, yes, the md's office needs to submit correctly. My epidural payment was denied because they didn't submit the right code. Once they did, it was paid with no problem.

Hope it gets solved quickly for you. How annoying!

Elizabeth
mommy to DD('04) and DS('06)

http://www.gynosaur.com/assets/ribbons/ribbon_gold_12m.gif[/img][/url]

[DebbieJ]

Can you call the insurance company and find out what the correct code is and then call the doctors office adn tell them the code to use?

I had to do that after a visit to Primary Care didn't get processed correctly. I finally had to call Blue Cross, then call the jerks at PCH to get it fixed.

~ deb
DS born at home 12/03
2 year check up: 25 lbs with clothes on and 35 inches!
BFARed for 20 months and 6 days
(Breastfeeding After Reduction is possible! www.bfar.org)

http://www.bfar.org/members/fora/sty...onths-bfar.jpg

[schums]

What a pain!! As if dealing with insurance isn't enough, now the doctor's office is being a PITA!

Try talking to the supervisor first, and explaining the problem in detail. It probably would help if you had the correct code, but the insurance company may not want to give it to you (fear of fraud).

If they still file it incorrectly, then call your insurance company and ask to speak to a manager/supervisor. Explain the situation to him/her (again in as much detail as possible) and ask him/her to call your doctor's office and help to get it straightened out. Sometimes they'll do a 3 way so you can be on the call too. We had to do this one time, and it really cleared things up fast!

HTH,
Sarah
Mom to Alex (3/2002) and Catherine (8/2003)

[overcome]

My advice is to:
1. Keep calling both dr office and insurance office until you get some satisfaction.

2. Don't pay ANYTHING out of pocket until this is resolved.

3. Don't give up!

Honestly, when I read 2.5 I thought you were going to say "years" and I wouldn't be surprised. I could tell you so many stories of my dealings w/insurance. I think it is a MAJOR problem in this country.

Good luck!
Ashley

[Momof3Labs]

The complicating factor is that it isn't just one code, it will be a whole series of codes for each step of the multi-week process.

I spoke to a supervisor (who didn't even have the heart to say "congratulations" when I pointed out that the baby resulting from this cycle had just arrived) and she blamed it on the insurance company. She said that she'd call them again and try to figure it out. Bleh, I just don't see an end in sight anytime soon, and it won't be long before I have to start battling my way through all the bills from Logan's birth!

[deenass]

Do not pay ANYTHING until this is resolved. No matter how many bills you get.

Always talk to the same person at your dr's office. Every time you call, say "may I speak to so and so." Write down the date you spoke with her/him and what action they said they were taking. The next time you speak with them, "remind" them "we spoke on 3/5 and you were going to call my insurance co." etc.

I usually call each time I receive a bill. Tell them that your insurance covers the procedure you had done, but when their office submitted the claim, it was submitted incorrectly. Tell them they need to resubmit it it with the correct codes, that you will not be paying the balance and that they need to deal with it. If need be, you can forward a copy of your insurance coverage to them.

[pritchettzoo]

We had this happen with the pediatrician--they were submitting one of Eli's bills under the wrong ID number. They eventually fixed it, but not before it was outside the time period for the insurance company to pay. The ped's office apologized and as far as I know, they ate the bill.

I would submit something in writing--fax it and mail it in. Maybe even certified. Otherwise you have no record of the conversation and have to repeat it ad nauseum to each and every person who answers the phone and passes you to the next person... Anyway, places seem to take things in writing more seriously.

Good luck!

Anna
Mama to Gracie (Sept '03) and Eli (July '05)

[mik8]

" would submit something in writing--fax it and mail it in. Maybe even certified. Otherwise you have no record of the conversation and have to repeat it ad nauseum to each and every person who answers the phone and passes you to the next person... Anyway, places seem to take things in writing more seriously."


ITA! In my previous experiences, writing did evoke a different impact than verbal action.