deductible applied when claims receive not in order of date of service
I have a provider who never submitted a claim from months ago, and now will submit.
Since the date of service, I met my deductible.
So had they submitted timely, I would have paid 100% and subsequent claims would have met deductible faster and paid out more. But instead subsequent claims already processed have been done without meeting deductible. So if this late claim is submitted and processed as of the date of service, one of 3 things could happen :
I am overcharged my deductible if new claim is treated as before meeting deductible
Late claim is processed as received, hence paid as if already met deductible
Late claim and all subsequent claims are re-processed to make sure the right deductible had been applied to each claim, possibly resulting in meeting the deductible sooner and reducing my share on some subsequent claims.
Now should this work at most insurers ? I use Aetna for now, curious both about Aetna but also in general if there is a standard way to handle this. Must come up all the time, but when I called Aetna the CSR kept me on the line a long time and didn’t seem confident in her answers.
Thanks for any insight.