won't bill insurance!!!!?

Question

I have been trying for MONTHS to get a provider to bill my ins. co., they pretend to be proactive and compliant, but my ins. hasn't received anything from them. A substantial amount of $ is at stake. Do I have any options/recourse? I already paid provider, of course...

Answer 1

If you can get a statement or receipt from the doctor, file the claim yourself. Most insurance companies don't require members/patients to use a HCFA 1500 or CMS 1500 claim forms. If you can get proof of 1. The treatment you received.(procedure performed) 2. Why you were treated (diagnosis) 3. Who treated you (doctor's name & address)... Then, you can file yourself. You'll also need proof of payment. Call the state board of medical examiners if you have problems; not your insurance company... The insurance company can't pay a bill they've never received.

Answer 2

If the provider is participating in your network of your insurance, it's part of their contract to submit claims to the plan - within the time alloted by the insurance. (If they miss the boat on what's called "timely filing", most plans tell them too bad, so sad and to suck it up - meaning you can't be billed.)

However, if they are not in your network, it might be in your best interest to submit the claims yourself so you don't get stuck with a bill. You can ask the provider for a claim form: called a HCFA (pronounced "hic-fah") where you send it into the insurance yourself. (Keep copies.)

If the first instance is your case - call your insurance plan and make sure they're aware of the situation. Sometimes claims don't go thru the system, they're lost in a "black hole", but the burden of proof is still on the provider to prove they submitted them.

Answer 3

Providers do not always bill insurance companies (and are not required to do so unless they are under contract with the insurance company in question to do so.)

If you've already paid the provider, you will likely need to file a claim form and show proof of payment to your insurance company in order to get reimbursed.

Good luck!

Answer 4

If you have already paid the provider then contact your insurance carrier and make a claim with them to be reimbursed. If you cannot get anywhere with the insurance company take the issue to your HR rep at work and they should be able to do something for you.