Humana health insurance denied claim
I’ve been dealing with a frustrating experience with trying to understand why a claim is being denied and hoping someone is familiar with this type of experience and can help in any way. So I had 2 counseling sessions last month with my insurance through Humana. It’s fairly new insurance so I’m not as familiar with it but I looked up thriveworks which is a counseling center where I live and it showed on the website it was covered through my insurance HMO plan. I received a claims summary following my appointments and it said it was denied. I had spoken with thriveworks prior to my appts and they said with my plan they looked up my services should be covered with $60 copay. I ended up speaking with Humana and it took awhile but we figured out that the npi number used was the actual counselor I’m seeing which shows in Humana that it’s not covered. If you put in thriveworks npi number it shows it as covered. So after an hour or so talking with Humana they said they were sending the paperwork to thriveworks to correct the numbers and reprocess it and it should be covered and there was nothing else i needed to do. Well today I received a smart summary for the month of July with all my claims and it has those two marked as adjusted but still shows it was denied and I owe the full amount. This stuff just drives me crazy and I am so frustrated trying to get answers. I can’t call thriveworks until Monday and I want to talk to them first and see if they got the paperwork and how it works with these npi numbers there. I would just assume if I’m using thriveworks and it says they are covered it would include all of their therapists that they employ. Just seems so stupid if it’s saying my insurance doesn’t accept her npi number but I’m not seeing her privately. I’m seeing her through thriveworks. It just hurts my head honestly trying to deal with this and I really loved this counselor so far but haven’t been able to go back bc this hasn’t been resolved. Hopefully this makes sense but I’d love to know other people’s experience with counseling coverage and if these npi numbers have been an issue for anyone and if it was able to be resolved. Thanks for reading
submitted by /u/Ok_Shift7194
[comments]
