Hi everyone,
I’d really appreciate any advice anyone has about trying to navigate this issue! I’ll give more of the basic details here so as to not write a novel, but I can provide more details if they’d be helpful.
Basically, my insurance has been rejecting claims I’ve filed for an out of network provider (but a covered service, in theory) many, many times (it’s been almost a year of submitting, getting rejections for confusing reasons, getting clarification, and fixing whatever error they say is the issue). Both me and my provider have been in communication with the company and are doing everything we can/everything they ask for… but now it feels like they’re just trying to delay things/get me to give up.
So far, the issues have been:
– invalid diagnosis/treatment codes (which we had to change 3-4 times to make sure it was right)
– “invalid” tax ID (it wasn’t invalid)
– invalid NPI number (also wasn’t invalid, but for some reason wasn’t working on their end… eventually, we fixed this one)
– when they didn’t like the tax ID, they said my provider could use her personal SSN. Then, they denied that, saying it was an invalid tax ID. I resubmitted that one with the documentation of the conversation my provider had with a representative that said the personal SSN would work, and…
– Now, the most recent one is the address. It’s technically a practice based in Canada, but it’s licensed/registered/legit as a virtual practice in the United States. The address on the receipts is correct. Yesterday, my provider’s office manager called and was apparently transferred around for about 3 hours because no one knew what to do.
Is there something I’m missing here?? I’ve seen a few out of network providers and I know that I (more than) hit my out of network deductible, because I’ve gotten other reimbursements. I know that I have out of network benefits, however minimal… but at this point, it really adds up (a year of weekly sessions… so even if I only get back like $20 per session, that’s still so much money I could get back… and I need it for all my medical issues!)
Thanks in advance! Am very new to this (26 y/o, and apparently was blessed with fantastic insurance at my first two jobs and then as a student because I never had these issues).
Also, it’s Anthem BCBS in VA.
submitted by /u/rawalmondbutter123
[link] [comments]
Hi everyone, I’d really appreciate any advice anyone has about trying to navigate this issue! I’ll give more of the basic details here so as to not write a novel, but I can provide more details if they’d be helpful. Basically, my insurance has been rejecting claims I’ve filed for an out of network provider (but a covered service, in theory) many, many times (it’s been almost a year of submitting, getting rejections for confusing reasons, getting clarification, and fixing whatever error they say is the issue). Both me and my provider have been in communication with the company and are doing everything we can/everything they ask for… but now it feels like they’re just trying to delay things/get me to give up. So far, the issues have been: – invalid diagnosis/treatment codes (which we had to change 3-4 times to make sure it was right) – “invalid” tax ID (it wasn’t invalid) – invalid NPI number (also wasn’t invalid, but for some reason wasn’t working on their end… eventually, we fixed this one) – when they didn’t like the tax ID, they said my provider could use her personal SSN. Then, they denied that, saying it was an invalid tax ID. I resubmitted that one with the documentation of the conversation my provider had with a representative that said the personal SSN would work, and… – Now, the most recent one is the address. It’s technically a practice based in Canada, but it’s licensed/registered/legit as a virtual practice in the United States. The address on the receipts is correct. Yesterday, my provider’s office manager called and was apparently transferred around for about 3 hours because no one knew what to do. Is there something I’m missing here?? I’ve seen a few out of network providers and I know that I (more than) hit my out of network deductible, because I’ve gotten other reimbursements. I know that I have out of network benefits, however minimal… but at this point, it really adds up (a year of weekly sessions… so even if I only get back like $20 per session, that’s still so much money I could get back… and I need it for all my medical issues!) Thanks in advance! Am very new to this (26 y/o, and apparently was blessed with fantastic insurance at my first two jobs and then as a student because I never had these issues). Also, it’s Anthem BCBS in VA.
submitted by /u/rawalmondbutter123 [link] [comments]Read Morer/HealthInsurance