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Popple | Help! Incorrect Insurance Billing for pregnancy? |
This is making my husband and myself crazy! I am 6 months pregnant and the Insurance Handbook clearly states that all my prenatal care is covered, with the exception on the initial $30 co-pay at the first visit.
Here's the problem:
My doctors office is called OBBYN Affilates and has 6 doctors. They registered with our insurance (Conventry Health) under the individual doctors names. When you search for a provider, it lists all 6 doctors as covered, but no where says OBGYN Offilates.
The billing office for the doctor keeps submitting claims under OBGYN Offilates, which is not recongnized by the insurance because this is not how they registered. So, we are getting charged a much higher out-of-network rate. The billing office is very rude and states that this is how they have always submitted there claims: OBGYN Offilates w/ the doctors name underneath. However, when looking at our claims on line, it does not say the doctors name anywhere and they are all denied with us owing a large portion. They wont even cover my routine ultrasound!
However, all my prenatal refills at the pharmacy are under the doctors name and they are approved!
We left a message for the office manager at my doctors office and are waiting for a call back. I already called them once and they did nothing.
I am really worried about the hospital bill if this is messed up now!
Any ideas on how to get this fixed? It is such a stupid problem, but no one will cooperate!
Thanks! Additional Details Yes, I wish knew this sooner! I had my first prenatal visit in May, but didnt start getting bills until the first of August and I was already out of my first trimester. |
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bud68
|
Forget arguing with the the billing office. Direct your complaint in writing directly to the doctor and request him/her to insure that THEIR billing office corrects the error and rebills correctly. |
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mbrcatz
|
The pharmacy coverage is different than the doctor coverage. It doesn't matter WHICH doctor writes the prescription.
You're going to have to call your insurance company, and if the doctor's office refuses to file bills under the name that the insurance company accepts, file the complaint with your INSURANCE company. Ask them if they'll cover, and if they won't, you really don't have any options besides switching doctors.
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sarah314
 |
Well, first of all, the insurance company does not read the name listed on the claim. No person actually "reads" the name on the claim - the computer system identifies the doctor based on the tax ID/provider number.
Also, the pharmacy part isn't really relevant. (It doesn't matter what doctor wrote a prescription - the "in network" or "out of network" status of a pharmacy claim is based on the pharmacy it is filled at. The doctor's network status has nothing to do with how a pharmacy claim is processed.)
You need to call your insurance company and ask them why the claims are processing as out of network. It could be a mistake on the insurance company's part, it could be a billing error from the doctor's office, or (hopefully this isn't the case) your provider could truly have had a change in network status.
The only way you're going to get to the bottom of this is by calling the insurance company. They are the ones who have the actual copy of the claim form submitted by the doctor, and by looking at that information they should be able to confirm whether it is being billed correctly.
I should note that most insurance companies made the final transition to using the NPI number this year. (NPI = National Provider Identifier. This is a universal number for all insurance companies. In the past, doctors may have had a different provider number for each insurance company. Now there is just one master number.)
There's always the possibility that the transition to NPI numbers is what's causing the problem with your claim. Any time there is a system change, there's always a few glitches. (Not saying that's definitely the case here, but its certainly a possibility!)
Call your insurance company - that's the next step you need to take to get this resolved. Good luck! |
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SusieQ
 |
Try talking to Coventry and explain the situation. Get something in writing listing the doctors and the Medical group name and send it to them. |
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k2t3
|
talk straight to the dr. see if anything else could be done.
too bad you didn't find this all out earlier when you could have changed dr's without 2 many visits. check with the hospital and make sure they are part of network before you deliver |
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