CarePlus? Claim denied? What is this?

Question

I got a notice from CarePlus about some service or something from more than a year ago. I'm not sure. I don't understand any of this.

"This is not a bill. You are not responsible for paying your doctor for this service. you do not need to respond to this letter. CarePlus is sending you this letter to tell you why we denied payment for your doctor or hospital - the reason is listed below.

A - Claim received without referral or authorization"

Billed amount - 394.00

Allowed amount - 6.50

denied amount - 6.50

amount paid - A (I'm guessing that's the reason)

Claim totals - 394.00

allowed amount - 6.50

denied amount - 6.50

amount paid - 0.00

net payment for claim - 0.00

non covered amount - 0.00

Okay... So it says the provider's name and address and the process date was on 8/20/08. I went to the hospital last year during February so I don't get it.

Er... can anyone tell me about this in simpler terms? Do I have to do anything? Will I be charged later on? Why is it processed now? It says stuff about appealing and stuff too.. I'm so confused!

Thank you in advance!

Answer 1

You do not have to pay for this treatment, it was the responsibility of the person providing the service to make sure they had a referral or authorization.  Hold on to this letter in case the provider trys to collect the money from you.