Optical Bill Question?

Question

I have vision insurance from work. My wife and I visited a Pearle Vision in June 2007. We paid our copay and out of pocket etc. Then in Feb 2008 I received a bill from Pearle Vision for the amount that the insurance was supposed to cover. I called my insurance and they said that an authorization was obtained but a claim was never filed for my visit. So I called up Pearle Vision, spoke to the store manager and then got the store manager and the insurance rep on the line to make sure that the store manager knows how to file the claim correctly. Yet, I still continue to receive a bill from Pearle Vision for the same issue. I have contacted the store manager and she said that she filed the claim. Yet, the insurance company keeps saying that a claim has not been filed. I am very fed up of this. I feel like I am being harrassed for something that is not my fault. And I'm worried that the bill is gonna end up on my credit report. Do I have any legal protection from claims in this case? Thanks

Answer 1

Not really.   The insurance company can deny any claim not filed within six months of the date of service.

Answer 2

Stay on both Pearle and the insurance company because if the claim does not get paid you are ultimately responsible, it in the fine print you signed with Pearle

Answer 3

This happens all the time.  They pull an authorization, provide the services and then forget to bill the insurance.  You are not the one at fault since it was Pearl vision who dropped the ball and never filed a claim.  If it's getting close to the 1 year mark, they probably have to file a paper claim to the insurance company and they probably don't have anyone there who knows how or wants to waste their time filling out the forms.  Be very careful about what happens next.  They might try to get a new authorization for this year once you are eligible for benefits again, and bill for the services you received LAST YEAR without providing you with any.  If your insurance company has no record of a claim for 2007, then it is up to Pearl vision to complete the process.  This should in no way affect your credit because it is not your fault that they didn't bill it in a timely manner.  Keep records of all your phone conversations with Pearl vision and your insurance company in case this does become an issue for you later.