I went to a clinic referred to by my doctor in May. Today 3 months later I reveived a letter from the clinic indicating "your insurance carrier still has not processed any payment towards your claim although we have filed on your behalf numerous times. For your protection, please contact your insurance company regarding this account and arrange for them to make payment immediately" So I called insurance co. they indicate they have no record of it and to call the clinic to see if they made the claim. Ok so I called the clinics billing dept they said the claim will not be in their name but a 3rd party billing they use and to check with the insurance co again and tell them to look under that name and see if payment was processed, and said this letter was a computer generated advisory and did not go to collections. I called insurance co again and they have found the payment info and they say the bill was paid in June and they have all the payment info (invoice #, check #, clam # etc). The insurance co rep put me on and off hold several times to find out from the insurance billing dept and sounded like something was not right then asked me if I can get a copy of the referral and fax it to her cause she needed the referral #. I am trying to see if the doc has the referral tomorrow. The rep also told me not to call the clinic again, so I asked her does this mean I need to deal with you guys and not the clinic? she said yep. Sounds to me like a screw up on the insurance co's part? They said they processed the payment but somehow the clinic does not have it? I mean how does that happen. What if the clinic does give the account to collections later on and ends up on my credit report if this is not corrected in a timely manner- are my chances good at getting this negative info removed? I am pretty sure the insurance co. will get this matter resolved when I contact them again Monday but there's always that what if. I hate getting caught in the middle arghhhh
I work for an insurance company and I can tell you that this does happen. Usually a wrong address problem, or it could be a problem with the check runs or sometimes the clinic doesn't post it to your account quick enough. I would keep checking with your insurance company to make sure the problem is resolved just to be on the safe side. Ask them to send you an explanation of benefits and this usually will keep the clinic from putting you in collections. For now at least.
***"I called insurance co again and they have found the payment info and they say the bill was paid in June and they have all the payment info (invoice #, check #, clam # etc)."*** When you call them back, ask them the who the check was made out to, the provider's address where the check was mailed, and whether or not that check has cleared the bank. ***"The insurance co rep put me on and off hold several times to find out from the insurance billing dept and sounded like something was not right then asked me if I can get a copy of the referral and fax it to her cause she needed the referral #. "*** Tell the insurance co rep that the referral number is: A.) Already in their system or they would not have paid the claim "already", as they claim. B.) Strategically located in Box 23 on the HCFA 1500 claim form that already submitted to them. C.) Electronically stored in their own referral and authorization system, and you are not going to do their work for them. You have followed the rules for receiving prior authorization, and received care from a participating provider. You have no reason to do their work for them and THEY should straighten out the error in their system. Also, if the insurance company referred you to the provider of service, the provider should not put you in bad debt anyway. They should put the debt into "Legal" bad debt and have their recovery agency go after the insurance company - not you. What state are you in? Are you HMO or PPO? In some states if you are an HMO member, they cannot bill you for services under certain conditions.
I was wondering the same thing, I was referred to the clinic and handed them the referral from the doc, if I didn't do that the clinic would not offer me services if they had no referral. The insurance co dug out the payment info from their system and wants me to get a copy of the referral from the doc, for what? If the insurance co did not get notice of the referral, the claim and payment would not have been processed in the first place am I right?I also remember when I asked the rep where the check was sent after she had told me the check # and the amount she put me on hold to find out and then came back on and told me if I can get a copy of the referral. I don't understand why I have to do this detective work for them. As a patient, I did what I had to do to get the services and I should do nothing more than that. Its up to the insurance co to get the claim processed and sent to the right place.
Well, ultimately, the responsibility for the bill is yours - WITH EXCEPTIONS depending on the contract between the clinic and your insurance. I would really be obstinate with them and make them do the leg work if you can do so without your credit taking a hit.
"your insurance carrier still has not processed any payment towards your claim although we have filed on your behalf numerous times. For your protection, please contact your insurance company regarding this account and arrange for them to make payment immediately" So I called insurance co. they indicate they have no record of it and to call the clinic to see if they made the claim. Ok so I called the clinics billing dept. they said the claim will not be in their name but a 3rd party billing they use and to check with the insurance CO again and tell them to look under that name and see if payment was processed, and said this letter was a computer generated advisory and did not go to collections. I called insurance CO again and they have found the payment info and they say the bill was paid in June and they have all the payment info (invoice #, check #, clam nyyanks81 ========================== This is S.O.P. running you back and forth between the provider and insurer passing the buck between them. LB 59
What business does the clinic have putting it in collections when you have the EoB proving that the clinic was paid??? L.B. 59
CaliGirl -------------------------- ================ I disagree: They aren't responsible for a bill that has already been paid by the insurer! No excuse for their credit taking a hit for a paid bill! LB 59
I am going through similar stuff with my Mom. Take my advice, pay it and then argue, if you value your credit rating. You do sign personal responsibility when you seek medical treatment, and it isn't worth having your credit ruined. They will reimburse you if they get double payment - I've done it many times..
I would agree with you if there was solid proof that the insurance company sent their check to the correct provider at the correct address. Since the person in this post did not state that she had the address information, then she cannot assume that the bill is paid to the correct person. I used to work for an HMO paying claims. I can tell you from experience that a provider can have several different addresses (offices). If a HCFA 1500 claim form comes in for services at one office and you send the payment to the wrong office address, it can take MONTHS to get that cleared up depending on the size of the practice. She needs to make sure the payment that the insurance company sent went to the correct provider.
Probably varies with the provider. I have contacted my Mom's provider every time I got a bill, and gone through the appropriate steps to get the insurance company to pay. In this case it is a typical screwup, and the provider knows we are working with them. I think this last one dragged on about 2 months from the time they sent a bill for it stating that they had not received the insurance payment. Prior to that I had seen the same claim being filed over and over (EOB's from medicare). Of course the provider was creating a new claim number evey time they filed, LOL, which has only increased the confusion. I called Tricare (the insurance company), and said, "if we pay this, are you willing to reimburse us when we send you the correct paperwork?" They said "Certainly" so I called the provider billing department and had them charge it to one of Mom's cards. In defense of Tricare, they have been great to work with. We were in the process of dropping a private insurer for Mom's medicare supplement, and switching to Tricare. I did not present Mom's military ID when I took her in (it was the emergency room), because I was used to giving them the other one, and of course, I was upset and not thinking straight.
I have lb on ignore, so I don't know if this was the entire post or not, but I can tell you this is why I have him on ignore. This is not the way to react. People who take this kind of attitude are creating their own problems. Refusing to pay when the situation gets screwed up is asking for trouble. You can say "it shouldn't be that way," if you like, and that's true. But that's the way it is, and if you want to keep a good credit rating, you had better deal with reality the way it is, not the way you want it to be. Pay it and then argue. quote: -------------------------------------------------------------------------------- Originally posted by lbrown59 CaliGirl -------------------------- ================ I disagree: They aren't responsible for a bill that has already been paid by the insurer! No excuse for their credit taking a hit for a paid bill! LB 59
ok so if I pay in the meantime, wouldn't the insurance company find out the bill was somehow paid and they don't have to pay the bill? and I wounldn't get reimbursed because of it? Because the insurance co said they have the payment info and I suspect it probably got routed somewhere else since the clinic did not get the money.
I don't understand this part. Did they give you a reason? I would stay in close contact with the clinic and the insurance company. Make it clear to the clinic that the insurance company has said that they paid the third party, but that if things are not cleared up by a specific date (pick one) that you will pay it and resolve the issue with the insurance company on your own, but that you expect their co-operation, to the extent that if they have been paid twice, they will refund your money. Then I would tell the insurance company and the third party (get the name and address from the clinic) the same thing. The best way to do all this is in writing, and I think, considering the possibilities, I would send it certified return receipt. I'm not saying don't talk to them on the phone, but after you do, send a letter detailing the conversation - each time. I don't think you need to pay them yet, but stay in close contact with all parties, and let them know that you are not just going to pay it and then go away.
If it does come down to it, and you end up paying the bill, just make sure you get a receipt and keep it. Then pursue your claim against the insurance company and the third party - whichever screwed up, or both if you can't find out who it was that screwed up. They have to reimburse you. Don't worry about that. If you end up having problems with that, email me, I can make them pay.
The insurance co rep told me to fax her a copy of the referral because it has a referral # on it and I do see the # imprinted on the referral, maybe they need that to match it up with the claim and see what the screw up was??? I am faxing it over tomorrow to the same rep and see what she tells me. If I remember correctly when I called the clinic, they told me that the claim was sent to the third party which handles payments for the insurance co. And the request for payment would be made by the third party (which is part of the insurance co.) and not the clinic name. So this means that the clinic's name would not be listed in the insurance co's system but instead the insurance co's own third party. Confusing enough? LOL
I think I will get a clearer picture on what the situation is when I send the fax over tomorrow, what sucks is that the insurance co's customer service is closed on weekends. Im also gonna find out from the rep how long this would take and see if they can expedite it, I am hoping no more than 2 weeks in getting the payment to the clinic to aviod more letters from the clinic. the letter stated: "your insurance carrier still has not processed any payment towards your claim although we have filed on your behalf numerous times. For your protection, please contact your insurance company regarding this account and arrange for them to make payment immediately" What does the "for your protection" mean? I don't really get it And is the clinic really asking me or the insurance co for payment or both in this letter? I mean it sounds geared more to the insurance co. The letter looks more like a letter rather than a "bill" format. If the clinic says they filed multiple claims does that mean there would be numerous transaction numbers or whatever you call it that the insurance company keeps getting and they would have a record of it? I mean if they do get multiple claims sent to them shouldn't that ring a bell to the insurance co that something is out of wack.
