Claim Repeatedly Rejected

Hi all! I need help navigating a situation that has gone on WAY too long:

12/22/23 – I visit a new PCP for a slew of problems. My bill comes to $595 (plus a $30 copay) for the following 3 services: Initial preventive medicine new pt age 18-39yrs, Office/outpatient visit est4, and Brief emotional/behav assmt. Provider submits claim to insurance.

12/29/23 – Insurance rejects claim due to "Missing or invalid information."

01/13/24 – Provider resubmits claim.

01/17/24 – Insurance rejects claim due to “Contact ID is Not On File or Member is not Active on Date of Service.”

03/12/24 – Provider resubmits claim.

03/19/24 – Insurance rejects claim due to “Member Not Eligible for the Submitted Date of Service.”

04/10/24 – I call insurance and am told that claim is not even visible in their system. They hypothesize that claim may have been submitted under incorrect Member ID number. (Our numbers changed on 01/01/2024.) Insurance representative personally calls provider, who connects her to provider's billing office, where she speaks with a representative and provides my 2023 Member ID number and claims address.

04/18/24 – I call insurance and am told that claim is STILL not visible in their system. Then I call provider's billing office and am told that claim has not been resubmitted (NOTE: It's been 10 days since they spoke with my insurance representative), but that they will "pass on my message" to the biller responsible for resubmitting the claim. I ask if I can personally speak with the biller, but am told they do not have a direct line.

My current situation is that I desperately need to see my provider for follow-up and prescription refills, but I am being told that I cannot be seen until my account balance ($595) is paid in full. I have gone back and forth between my provider, my insurance, and my provider's billing office multiple times since December. I feel like I've done everything possible on my end. What are your recommendations?

submitted by /u/demetertess
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