Provider won’t send claim correctly, what else can I do?
Brief rundown, I’ve posted before, back in November, we were out of state and my type 1 toddler was ill so I took him to urgent care (in-network) to get checked out since we were far from home and having a sick diabetic child is scary. I only had my debit card on me, and to be seen I had to give it to them.
Provider submitted the claim incorrectly and it was denied. I was sent EOB which stated in-network provider needs to send it to xyz. Provider also auto-debited my debit card the balance ($150) for the insurance portion, i already paid my copay of $90 as well. Provider did not send me the bill, they just charged my card used for copay. They said they will not refund me until insurance pays but they also cannot send claim correctly so no refund for me!
Things I’ve tried:
Multiple calls to provider and insurance on what to do. Multiple 3 way calls where I have heard myself hear insurance tell provider where to send claim. Claim has been sent both electronically and by paper mail per insurance instructions.
I have finally had this issue escalated by my insurance and this is the latest response I got today:
“I apologize for the many attempts you’ve made to resolve this matter.
Although the provider has been advised multiple times where to submit the claim, they continue to submit it to Highmark Blue Cross Blue Shield incorrectly.
Our records indicate that the latest claim was received on 3/25/24. The claim was assigned claim number xxxxxx. The claim denied due to the provider submitting the claim to Highmark Blue Cross Blue Shield . The claim is denying towards the provider’s liability, which is why you are seeing a $0 member liability.
I will have the provider contacted again, but the claim is denying correctly as due to contractual obligations, the provider must submit to the correct payor/contractor. That would be Independence Blue Cross.
I will be sure to follow up with you once I receive additional information.”
Anything else I can do? The last time I called the provider at the end of March and tried to explain to the billing person that they aren’t sending it to the right BCBS I was met with an attitude and “we are sending it per the instructions on your insurance card”. She even made me read it out loud and refused to send it any other way. I told her she needed to send to independence BCBS NOT BCBS of PA, and she told me I was wrong.
I know $150 doesn’t seem like a lot, but with all of the medical bills we have to deal with with having a type 1 diabetic child, I refuse to pay something I don’t have to.
And the only way I got this escalated with insurance was contacting BBB, calling customer service didn’t yield much.
submitted by /u/No_Panda_9171
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