I have an issue which requires weekly treatment. I obtained a predetermination, and have been getting that done.
The provider is Out of Network, but I was told that they would be treated as in-network due to the predetermination.
I started sessions in November. The first one processed a little over a month later, and initially processed as OON. Called up, they fixed it after escalating over the course of 2-3 calls. They told me they placed a ‘manual calc’ and a lock on similar claims to prevent the issue.
Another 4 have since processed (again OON), and I was able to get those fixed and processed as in-network after a few more calls. But more keep piling up. I now have 9 more stuck as OON, and I’ve been calling weekly to try and get things fixed (22 calls and counting).
Some claims have been waiting on their system to process them since Jan 5. I’ve been repeatedly told everything I’m doing is correct, I filed the claims by paper myself, but they’re having difficulty figuring out how to fix things. I’m currently owed over 4k, and it’s getting a little ridiculous. They’ve once even claimed that they get locked out of the account for a week once they make a change, and so just be patient. But when I’m getting a new wrongly-processed claim each week, what other option do I have?
Is there any way to force more-prompt action?
Edit: Live in MD, but plan is BCBS of IL
submitted by /u/somdude04
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I have an issue which requires weekly treatment. I obtained a predetermination, and have been getting that done. The provider is Out of Network, but I was told that they would be treated as in-network due to the predetermination. I started sessions in November. The first one processed a little over a month later, and initially processed as OON. Called up, they fixed it after escalating over the course of 2-3 calls. They told me they placed a ‘manual calc’ and a lock on similar claims to prevent the issue. Another 4 have since processed (again OON), and I was able to get those fixed and processed as in-network after a few more calls. But more keep piling up. I now have 9 more stuck as OON, and I’ve been calling weekly to try and get things fixed (22 calls and counting). Some claims have been waiting on their system to process them since Jan 5. I’ve been repeatedly told everything I’m doing is correct, I filed the claims by paper myself, but they’re having difficulty figuring out how to fix things. I’m currently owed over 4k, and it’s getting a little ridiculous. They’ve once even claimed that they get locked out of the account for a week once they make a change, and so just be patient. But when I’m getting a new wrongly-processed claim each week, what other option do I have? Is there any way to force more-prompt action? Edit: Live in MD, but plan is BCBS of IL
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