Losing my patience with claim
I’ll keep it simple LOL!
Oct 2021 Dr appt
November 2021 Provider submits claim to insurance ($607 less contract discount $482 leaves $125 allowed charges) – insurance denies citing ‘incorrectly coded per ICD10 manual’ – insurance issues EOB which says member responsibility $0.00
November 2021 I call provider and ask them to resubmit with correct code. I am asked ‘do you know what the code should be’ – I consider a witty retort ‘would you like me to do your job for you’ but keep quiet. Rep says she’ll pass it to claims to resubmit but it could take ‘a while’.
April 2022 I receive bill from provider for $897 ‘insurance pending’ $386 – I owe $511. Hmmm I check insurance website, no claim has been resubmitted. Where did these numbers come from? I call provider, they can’t explain, I ask them to resubmit claim, they say they will pass to claims but it could take a ‘while’.
May 2022 I receive notification I have a new EOB. I check I don’t, but I wait and check the next week. It’s there for the original amount $607 less $482, still showing member responsibility $0.00 but it’s been denied due to ‘not being submitted in a timely manner’.
I call provider, ask what to do. They don’t know, maybe call insurance and appeal. I ask shouldn’t you be appealing since they say you didn’t submit it in time. They don’t know. I ask if I can pay the $125 just to get it over and done with. I’m moving and don’t want this outstanding. She says my account shows no payment due so she can’t take a payment. I ask if it shows no payment then is the claim closed? She doesn’t know, maybe they’ll try billing me again. But I should call my insurance to ask what to do.
You really couldn’t make this crap up….
