Professionals who examine medical claims?

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Topic Author
BowlingForBabies2002
Posts: 19
Joined: Mon Jan 06, 2020 4:11 pm

Professionals who examine medical claims?

Post by BowlingForBabies2002 »

DW had surgery in 2021 while covered under two medical insurance coverages. The facility switched the primary/secondary order and has caused a massive headache trying to get all the billing correct.

Is there a professional service that will look at all the claims and what insurance paid to make sure we are paying the right amounts?

We've paid bills as they came in, only to have the claims reprocess after the fact and now are owed refunds (in the thousands of $) and its just getting too much to handle on my own. The refunds aren't happening automatically, but after we have to call and request them.

One of the insurance companies turned off our online access so we can't even look at anything, and the other is only being minorly helpful.

I've spent pry 40+ hours on the phone just trying to make sure everyone gets paid so I don't have to worry about anything getting sent to collections.

And to top it all off, some of the providers aren't returning phone calls, so I can't even pay them!
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ResearchMed
Posts: 12932
Joined: Fri Dec 26, 2008 11:25 pm

Re: Professionals who examine medical claims?

Post by ResearchMed »

BowlingForBabies2002 wrote: Fri Jan 14, 2022 2:03 pm DW had surgery in 2021 while covered under two medical insurance coverages. The facility switched the primary/secondary order and has caused a massive headache trying to get all the billing correct.

Is there a professional service that will look at all the claims and what insurance paid to make sure we are paying the right amounts?

We've paid bills as they came in, only to have the claims reprocess after the fact and now are owed refunds (in the thousands of $) and its just getting too much to handle on my own. The refunds aren't happening automatically, but after we have to call and request them.

One of the insurance companies turned off our online access so we can't even look at anything, and the other is only being minorly helpful.

I've spent pry 40+ hours on the phone just trying to make sure everyone gets paid so I don't have to worry about anything getting sent to collections.

And to top it all off, some of the providers aren't returning phone calls, so I can't even pay them!
I haven't had a situation like this, so can't help too much with the specifics of dealing with two different insurers.

However, I'm a bit concerned that one insurer "turned off" your online access. Is this access something that is routinely available to those who are covered by this insurer? If so, I'd find that extremely worrisome.

Have you considered speaking with someone at your state's Insurance Commissioner's Office (or similar oversight agency)?
(And especially if they have turned off access that is routinely available!)

Is this by any chance an Employer-sponsored health insurance plan?

You might not want to involve them (HR?) due to privacy reasons, of course.
However, if privacy isn't a concern, that might be worth considering.

One time we met total incompetence trying to get reimbursement for a relatively small (a $1k - $2k amount) out of country procedure, something that IS covered by our plan... or was supposed to be... Employer self-insured, but used a "big name" insurer to administer the claims.
They kept misplacing the forms we sent in, and other repeated problems.
I finally contacted HR, and told them that the insurer was basically about to run out our clock on our travel insurance, but we were required to get costs reinbursed by our primary insurer OR get a denial... not a "can we have yet another copy of the bills..." :annoyed

The HR person got the same runaround, and explained, "They aren't used to processing foreign claims..." Well, that's unfortunate, but we still needed to get paid!

But that was what it took.
[We now have travel insurance that is "primary", meaning no need to submit claims to any other insurer first!]

Mumbling "Insurance Commissioner's Office" or perhaps asking, oh so politely, something like "Would it help if we asked the Insurance Commissioner's Office to help with this?" might get some additional attention... but only if you can actually reach someone!
If not, then that's where I'd head if there's just no progress.

Do keep good notes about dates/times of calls and, if possible, rep names or "ID numbers" or such.
You don't want to run out of time and then have that invoked as a reason for denial.

RM
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bsteiner
Posts: 6431
Joined: Sat Oct 20, 2012 9:39 pm
Location: NYC/NJ/FL

Re: Professionals who examine medical claims?

Post by bsteiner »

Topic Author
BowlingForBabies2002
Posts: 19
Joined: Mon Jan 06, 2020 4:11 pm

Re: Professionals who examine medical claims?

Post by BowlingForBabies2002 »

ResearchMed wrote: Fri Jan 14, 2022 2:22 pm
BowlingForBabies2002 wrote: Fri Jan 14, 2022 2:03 pm DW had surgery in 2021 while covered under two medical insurance coverages. The facility switched the primary/secondary order and has caused a massive headache trying to get all the billing correct.

Is there a professional service that will look at all the claims and what insurance paid to make sure we are paying the right amounts?

We've paid bills as they came in, only to have the claims reprocess after the fact and now are owed refunds (in the thousands of $) and its just getting too much to handle on my own. The refunds aren't happening automatically, but after we have to call and request them.

One of the insurance companies turned off our online access so we can't even look at anything, and the other is only being minorly helpful.

I've spent pry 40+ hours on the phone just trying to make sure everyone gets paid so I don't have to worry about anything getting sent to collections.

And to top it all off, some of the providers aren't returning phone calls, so I can't even pay them!
I haven't had a situation like this, so can't help too much with the specifics of dealing with two different insurers.

However, I'm a bit concerned that one insurer "turned off" your online access. Is this access something that is routinely available to those who are covered by this insurer? If so, I'd find that extremely worrisome.

Have you considered speaking with someone at your state's Insurance Commissioner's Office (or similar oversight agency)?
(And especially if they have turned off access that is routinely available!)

Is this by any chance an Employer-sponsored health insurance plan?

You might not want to involve them (HR?) due to privacy reasons, of course.
However, if privacy isn't a concern, that might be worth considering.

One time we met total incompetence trying to get reimbursement for a relatively small (a $1k - $2k amount) out of country procedure, something that IS covered by our plan... or was supposed to be... Employer self-insured, but used a "big name" insurer to administer the claims.
They kept misplacing the forms we sent in, and other repeated problems.
I finally contacted HR, and told them that the insurer was basically about to run out our clock on our travel insurance, but we were required to get costs reinbursed by our primary insurer OR get a denial... not a "can we have yet another copy of the bills..." :annoyed

The HR person got the same runaround, and explained, "They aren't used to processing foreign claims..." Well, that's unfortunate, but we still needed to get paid!

But that was what it took.
[We now have travel insurance that is "primary", meaning no need to submit claims to any other insurer first!]

Mumbling "Insurance Commissioner's Office" or perhaps asking, oh so politely, something like "Would it help if we asked the Insurance Commissioner's Office to help with this?" might get some additional attention... but only if you can actually reach someone!
If not, then that's where I'd head if there's just no progress.

Do keep good notes about dates/times of calls and, if possible, rep names or "ID numbers" or such.
You don't want to run out of time and then have that invoked as a reason for denial.

RM
Thank you for the response. I have been keeping track of all phone calls and notes. Luckily it looks like we are starting to get somewhere today. We've gotten the refunds started, and confirmation that one of the mail outstanding bills has been properly processed by the primary insurance, knocking it from $1200 down to $50 before secondary insurance kicks in. So today has been a $4000 net positive!

Still kind of frustrated that a bill first showed up 8 months later and everyone is saying it is valid, but like I've told everyone so far, I WANT TO PAY YOU WHAT YOU'RE OWED!

I think my main concern now is the providers that aren't returning phone calls. I've had the insurance company call them too on our behalf, and they haven't been returning those calls either.

I suppose that is due diligence on our end for preventing anything from sticking to DW's credit
Katietsu
Posts: 5531
Joined: Sun Sep 22, 2013 1:48 am

Re: Professionals who examine medical claims?

Post by Katietsu »

Please see this from Experian:

https://www.experian.com/blogs/ask-expe ... dit-score/


You should have plenty of chances to keep DW’s credit in good shape. Hopefully, this will give reduce your concern.
Topic Author
BowlingForBabies2002
Posts: 19
Joined: Mon Jan 06, 2020 4:11 pm

Re: Professionals who examine medical claims?

Post by BowlingForBabies2002 »

Katietsu wrote: Fri Jan 14, 2022 9:51 pm Please see this from Experian:

https://www.experian.com/blogs/ask-expe ... dit-score/


You should have plenty of chances to keep DW’s credit in good shape. Hopefully, this will give reduce your concern.
Thank you, we will be sure to monitor her credit and watch for things to get posted.
Duzz78
Posts: 71
Joined: Sat May 15, 2021 9:10 pm

Re: Professionals who examine medical claims?

Post by Duzz78 »

Spouse's work provides such a service through Health Advocates. I used them about 5 times through the years for billing issues. Each advocate resolved my issue every time.

Bsteiner provided you a name of a Health Advocate.
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