Posted on 01/04/2017 7:49:06 AM PST by italianquaker
We work with several doctors and consistently receive calls from patients who are requesting that we verify benefits and coverage for them before they make an appointment for services. Have heard the statement “But you’re listed as in their network” more times then I can count after I tell them the doctor is not in their network.
Insurance carriers combine and expand networks all the time and allow employers or third party administrators to use their networks without the provider agreeing to be in a specific part of their network.
Best bet is always have the doctor or service provider confirm your benefits before you are ever seen. Keep a record of the verifier’s name, date and time they gave you the benefits. You might even wish to have them email you the benefits they are quoting. You simply should never believe anything you read on the internet when it comes to insurance companies.
Brah-VO! Good for you. Excellent.
Our new insurer has a “concierge” function. Supposedly, if you have any issue, you just contact them, let them know and THEY are to do the homework. I have yet to try it out, but maybe it will only be a part-time job now...
http://www.medicalclaimshelp.org/home1.aspx
from above link:
“Sometimes getting a medical claim paid correctly can be a real battle. It starts when a charge that should be covered is denied. You call customer service, and they tell you that it will be reprocessed. Then, in a few days, another denial arrives with a brand new denial code. You call again. It’s denied again. And it may stay that way if it’s stuck now in this health insurance claims adjudication netherworld where nothing is paid easily, if at all. “
Recently a clinic manager told me; “Resolving wrongly denied medical claims used to be a simple process. A biller working in our office would stamp “APPEAL” in big red letters on a photocopy of the claim, and mail it back to the insurance company. These days, you’d be wise to put the cost of that postage in the bank, and throw away both the APPEAL stamp and its red ink stamp pad because it won’t even make it past the insurance company’s initial computer screening. They’ll toss it into the trash and you’ll never hear anything back from them. Today, you need to get your ‘A-game’ on. Otherwise, you won’t see a penny.”
Our insurer denied an appeal in a way that made it very clear their people were either stupid, ignorant or blind. I chose blind.
In my response, I suggested the Stevie Wonder and Ray Charles, their Nurse Practitioner and Appeals specialist be replaced with someone who can see and therefore be able to read.
I’m sure that one’s hanging on a wall somewhere. Of course, it was ignored.
When bad goes to worse the best path might be to hire a specialist. Start with ‘free information’...
Claims specialists tend to charge between $50 and $100 an hour... Consultation is usually free.
free information at: www.medicalclaimshelp.org
Alliance of Claims Assistance Professionals - www.claims.org
Above links from Kiplinger Retirement Report
thanks. I really appreciate it. This one has been driving me crazy
LOL
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