Won't bill insurance!!?
I have be 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 hold any options/recourse? I already paid provider, as you would expect...
Answers:
If you can get a statement or bill 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 procure proof of 1. The treatment you received.(procedure performed) 2. Why you were treated (diagnosis) 3. Who treated you (doctor's term & address)... Then, you can file yourself. You'll also obligation proof of payment. Call the state board of medical examiners if you hold problems; not your insurance company... The insurance company can't pay a bill they've never received.
If the provider is participating in your lattice of your insurance, it's part of their contract to submit claims to the plan - inside the time alloted by the insurance. (If they miss the boat on what's called "timely filing", most plans put in the picture them too bad, so distraught and to suck it up - meaning you can't be billed.)
However, if they are not contained by your network, it might be surrounded by your best interest to submit the claims yourself so you don't get stuck near a bill. You can ask the provider for a claim form: called a HCFA (pronounced "hic-fah") where on earth you send it into the insurance yourself. (Keep copies.)
If the first instance is your grip - call your insurance plan and build sure they're aware of the situation. Sometimes claims don't go thru the system, they're lost contained by a "black hole", but the burden of proof is still on the provider to prove they submitted them.
Providers do not other bill insurance companies (and are not required to do so unless they are under contract next to the insurance company in cross-question to do so.)
If you've already paid the provider, you will imagined need to directory a claim form and show proof of payment to your insurance company within order to bring back reimbursed.
Good luck!
If you hold already paid the provider after contact your insurance carrier and sort a claim with them to be reimbursed. If you cannot bring anywhere with the insurance company lift the issue to your HR rep at work and they should be able to do something for you.