Insurance Problems

This is absurd, and you shouldn't have to deal with this. Have you gone to the biller working with your ps. They are the ones who need to fix this. There are laws protecting us from things like this and it seems whoever submitted the information must have done something wrong.

Ridiculous, it's always something....isn't it?

This is so maddening--and an example of just how far the insurance companies will go (and the contortions they will perform) to evade both the 1998 statute and the ACA. Everything started to go downhill when HMOs replaced medically-trained personnel with bean-counters in their Utilization Review depts.--and it spread basically to managed-care plans in general. It’s outrageous that someone with two years of junior college or less (in a non-science field) can have the power to veto the sophisticated medical decisions of physicians & surgeons. I am so glad I finally made it on to Medicare (although even they have arbitrary cutoffs & exclusions--LE compression sleeves are not covered but 2 bras a year are? And PT sessions are capped even if the problem is not resolving or is even worsening).

Until we eliminate the profit motive from health care, it’s only going to get worse. Yes, providers have a right to make a living--but not to make a killing (and I say this as a doctor’s wife). Insurers’ profits keep increasing as benefits shrink and premiums rise. What’s wrong with this picture?

While I've had my "go-arounds" with insurance companies, I find many doctor's billing staff don't understand the new coding system and how their work impacts whether claims will be paid for or not. In good offices, it is seamless, in offices where there are disconnects in the practice (left hand not knowing what the right hand is doing) it can be frustrating. I had the insurance company not pay the plastic surgeon for one of my surgeries, I was not getting billing notices but I would check from time to time. I brought it up to the PS, he was totally unaware that he hadn't been paid in over six months and that his office simply needed to send in one piece of information. Problem solved. We had another doctor's visit for my husband denied as "out-of-network", the doctor had been in the network for years. Turns out the billing staff had sent in the claim as "out-of-network". That one took having the insurance company and the billing office on the line at the same time to get it solved as they both kept telling me it was the other that needed to make a change in the paper work. It was the doctor's office that needed to make the correction.

Good luck.