This is kind of a weird situation, so I’ll do my best to explain it as briefly as possible. My wife has about 6 claims from late 2019/early 2020 that were initially paid by insurance (she was on as a spouse through my employer), but in December 2020, they found a different plan opened under her name (both plans were under the Anthem umbrella) for that time period, so they withdrew payment for those claims citing a coordination of benefits issue. We didn’t become aware of it until we started receiving bills earlier this year. What we eventually figured out was towards the end of 2019, she became eligible for coverage through a TV show she was working on. They sent us an information packet requiring us to opt out of the coverage, which we never received, and automatically enrolled her without our knowledge. We were able to get that coverage retroactively terminated, and sent a Certificate of Creditable Coverage to the original insurance company showing the plan was no longer valid for that time frame. I spoke with a customer service rep on the phone and was told they would reprocess the claims, but it would take 45 business days to do so. It’s been well over 60 and still no payment has been made. I plan on calling them again first thing Monday morning and immediately asking for someone in a supervisor role (I’ve had to do this with other insurance companies in the past) but am curious is anyone has and recommendations on other documentation to prepare or key words to use in the conversation to help expedite the process. The bills are roughly $2k, and are all the responsibility of the insurance company (wife had reached her OP Max, and all were in-network as the insurance company paid them initially) and we’re now approaching the 2 year mark for the earliest date of service on some of the claims.
submitted by /u/DraveDakyne
[link] [comments]
This is kind of a weird situation, so I’ll do my best to explain it as briefly as possible. My wife has about 6 claims from late 2019/early 2020 that were initially paid by insurance (she was on as a spouse through my employer), but in December 2020, they found a different plan opened under her name (both plans were under the Anthem umbrella) for that time period, so they withdrew payment for those claims citing a coordination of benefits issue. We didn’t become aware of it until we started receiving bills earlier this year. What we eventually figured out was towards the end of 2019, she became eligible for coverage through a TV show she was working on. They sent us an information packet requiring us to opt out of the coverage, which we never received, and automatically enrolled her without our knowledge. We were able to get that coverage retroactively terminated, and sent a Certificate of Creditable Coverage to the original insurance company showing the plan was no longer valid for that time frame. I spoke with a customer service rep on the phone and was told they would reprocess the claims, but it would take 45 business days to do so. It’s been well over 60 and still no payment has been made. I plan on calling them again first thing Monday morning and immediately asking for someone in a supervisor role (I’ve had to do this with other insurance companies in the past) but am curious is anyone has and recommendations on other documentation to prepare or key words to use in the conversation to help expedite the process. The bills are roughly $2k, and are all the responsibility of the insurance company (wife had reached her OP Max, and all were in-network as the insurance company paid them initially) and we’re now approaching the 2 year mark for the earliest date of service on some of the claims.
submitted by /u/DraveDakyne [link] [comments]Read Morer/HealthInsurance