| If you are trying to submit medical insurance claims | | | | 'telling them where to find the claim". |
| for a provider who is out of network with the | | | | The funny thing was that we received a letter that |
| insurance carrier you will most likely run into some | | | | day with the claim being returned stating that the |
| problems. For example, if you need to call on the | | | | type of bill was not a valid type of bill code. Isn't it |
| claim you may find that the insurance carrier will not | | | | amazing that we were told such different information |
| even speak to you since you are out of network. | | | | when we called? Well our type of bill certainly was |
| This makes following up on the claim difficult. | | | | valid, but it turns out that Blue Cross just requires a |
| Some wonder why you would want to follow up on | | | | different type of bill. Now we've resubmitted the |
| a claim that is out of network. Sometimes it is not | | | | claim with the new type of bill and you can bet we |
| the provider's choice to be out of network. Or | | | | will keep calling until payment is made. |
| possibly they are trying to help the patient out. In | | | | There are other problems that you can run into |
| our case, it was an inpatient drug rehab that just | | | | when submitting out of network claims. In some |
| opened, still applying to be in network, but accepted | | | | cases patients have no out of network benefits |
| the patient as an insurance patient. They had us | | | | which means no payment will be made on the |
| submit the claim but they are waiting for the | | | | services. Usually out of network claims are paid |
| payment. | | | | directly to the patient and this may not be a problem |
| We submitted the claim and then called 2 weeks | | | | for you if you are just verifying if the claim was paid. |
| later to be advised the claim wasn't on file. We then | | | | If you are waiting for the payment then it can be |
| faxed them the claim and called again 1 week later. | | | | helpful to know when the patient is receiving the |
| Now we were told the claim was received and was | | | | money. |
| in process. Fortunately we didn't rest on that | | | | For those of us who are responsible for submitting |
| information. We called again 1 week later to find that | | | | out of network claims for providers we just have to |
| the claim was 'lost'. Now I couldn't figure out how it | | | | be diligent in following up on the claims. It is not an |
| could be lost since we were told it was received and | | | | easy task but if you just stay on top of it, it can be |
| in process, but this new person was now telling me | | | | done. |
| that she was sending it back for processing and | | | | |