I received a medical bill that insurance should have paid?

Question

Near the end of my last semester of College, I received an MRI/MRA for my head with Student Health Insurance through Blue Cross. Now, three months later, I have received a patient statement saying that my insurance was billed two times without receiving any payment. I called the university health insurance office and the guy I talked to said that there were no records of my authorization of the MRI/MRA at Blue Cross. He said he would have the records be refreshed and that my authorization should show up and that this process will take about a month. Now, I'm thinking WHAT THE F***????? Why the h**l isn't my authorization on record in the first place? Shouldn't this have been handled already three months ago? It just doesn't really make sense to me that this is an issue. Is this a common problem that happens? Because this all seems ridiculous to me. Also, he said refreshing the records will take about a month and my insurance expires in less than a month, so will that become a problem? I am very frustrated because random sh*t has been happening all year causing me and my family to lose lots of money and have lots of stress.

Answer 1

I don't know, but this refreshing the records sounds bogus to me.  He may be stalling you.

Call back and ask for a supervisor.  See if they can get this paid for you.  After that, go for the manager.  Make your own notes of the date and time you called them.  Be sure to get the name of who you spoke to.  Call them by name - like, "Thanks for getting this straightened out, Bob".  That lets them know you'll be holding them personally responsible for what they do or don't do.

Since your procedure was done when your policy was in force, it will be covered.

Good luck.  Insurance companies love to give you the run around.  Be patient and keep your cool.  Make them dread coming to work wondering if you're going to call again.  Maybe then they'll get the bill paid.

Answer 2

~~I don't know what type of insurance you have (HMO, PPO?) but call the insurance company and ask for a supervisor. Get their name and fax number. Then call your doctors office and speak directly with the insurance biller. Ask that person to submit the claim along with the authorization (hardcopy if they have it or number if they do not), and have them fax it directly to the supervisor. Then call the supervisor everyday if necessary and get them to pay the claim. Don't worry about the insurance expiring you will still be covered for any date you had treatment while you had the insurance. Unfortunately-insurance companies work hard at not paying the claims, and since your doc is coming after you for payment you need to do the footwork, Be firm and let them know you will file a complaint with the insurance commissioner of your state if they don't resolve this immediately!~~

Answer 3

It's common.  I spend a LOT of time chasing down Cigna to pay my family's personal health claims.  

Don't wait a month, though, follow up next week.  Write down the names of who you talk to, what they say, and the date/time of call.  

The expiration of your insurance in a month, shouldn't matter at all.

Answer 4

You should keep calling them. I hope they pay it.

Answer 5

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Answer 6

Student health insurance policies are notorious for having pretty bad coverage.

If I'm reading your question correctly, you did get a pre-authorization for your MRI, correct?  Glad to hear that, otherwise it might be a little trickier to get the claim paid.

I'm not sure what you mean by "records refreshed."  Do you mean that he was going to have your claim adjusted?  If so, that sounds about right...that it would take up to 30 days for the provider to receive payment  after a claim was adjusted.  (Medical providers don't receive an individual check for every patient...they receive one large bulk check every couple of weeks for multiple patients at once, which is why it might take up to 30 days for them to receive your payment.)

Your insurance coverage goes by the date services were done.  Even if your insurance policy expires next month, that shouldn't be an issue as long as the services were done while the policy was still in effect.