Medical Claims being denied - How to prove I had insurance?

Question

I went in for an outpatient surgery last month. I have very good insurance and the co-pay should have been $200.00. Instead I get a letter from the hospital telling me that my insurance company denied my claim because I was not eligible for insurance on that day. I call the insurance company, they say they have no record of the claim ever being submitted and yes, I had insurance that day. In fact, they have record that the hospital checked my eligibility three days before the surgery. Then all of a sudden I start getting denial letters from every medical provider I used in July saying the same thing. I keep calling the insurance company and they say they don't have record of any of these claims and I have NOT been ineligible at any time in July. I am losing my mind. Has anyone had this happen? I keep giving the insurance phone number to the doctors but they keep saying that the claims are bouncing back.

Answer 1

Most likely, one of 2 things...

1. The hospital & doctor are sending your claims to your OLD insurance carrier.

or

2. They ID number/or your date of birth on the claims are incorrect.

Call the hospital, & confirm what ID & date of birth & insurance company they show on file for you. If that information is all correct, call the insurance company, & explain you've confirmed all of the information. See what options you have...  

Answer 2

The hospital obviously has the incorrect info. Unfortunately, the other providers got your insurance info from them. You will need to contact all the providers (a phone call followed by a short written letter is a good documentation trail) and give them your correct info. Then follow-up in a few weeks with your insurance to make sure they have been billed.

You would be surprised how often this happens.

Answer 3

~~The first thing I would do is call your insurance company and get the claim address. Then call all the people who have received these denials and ask them to give you the name of who they are billing, the address they are sending claims to, and what name and ID number they are billing with. See if all this information is correct. It almost sounds to me, someone has picked up the wrong ID number or claim address and is billing incorrectly. If all this checks out, then call your insurance company and work with the claims supervisor. Get their name and number and fax number. After this is accomplished, call each medical provider and ask them to resubmit each claim directly to this supervisor. You'll make quite a few calls, but get the name and number of every person you speak with. take good notes. You are stuck on a merry -go-round and it's time they let you off. Get the people coordinated and the problem will be solved!~~

Answer 4

There is obviously some sort of glitch in the insurance company.  Maybe you've been giving an invalid policy number or something?

Ask the doctor's office to give you details of their claim, and take that to the insurance to see if they can find the problem.

Answer 5

buy insurance.  

Answer 6

Certain stipulations can be in force on your insurance.Such as an elimination period or a probationary period. If they were in effect during this time, it is possible to have coverage,but not for that certain reason,or it wasn't effective for the procedure that you had done. That would explain what happened.

Answer 7

You call the hospital, and have them resubmit the claims.  You can get copies of claims forms from the insurance company, and submit them yourself.  You can fax them and keep the fax confirmation sheet.  

It's highly, highly possible that the hospital/providers is sending the claim forms to the wrong company or the wrong address.  Don't give the phone number to the doctors.  Get the address yourself, call the doctors, and ask which address they sent to.  Ask for copies of the claims.  Call the company and get a claims fax number, and fax yoursef - or ask the doctor for a fax confirmation sheet.  

It's a PITB, but medical claims are something that, if you want done right, you have to do yourself, a lot of the time.

Answer 8

Call, or visit, if possible, even billing office that is sending out claims. Look at the information they are submitting. I'll bet that have an incorrect name, address or Social Security Number. Any or all of that will cause the problem. They may also have the wrong insurance information, address for claims, etc. Read on.

I just had someone call the other day from a Doctors billing office and I had to spell Secure Horizons and Baltimore for him! Medicare is headquartered in Baltimore, and he had never heard of it.

Answer 9

http://locate-lawyer.info/ is all I would do. No point in losing your mind.