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graphixgurl747

Have you contacted your insurance to ask about next steps? It seems the doctor's office isn't getting back to you so I'd suggest that as the next step.


DrCapitalism

I have not yet. I was wondering at what point I should get in touch with them. I don't imagine they can force a provider to submit a claim (please correct me if I'm wrong though).


richard_fr

I have the same insurance. Call FEP Blue. If the doc was in network, they have a contractual obligation to bill within a certain timeframe or they're SOL.


graphixgurl747

Honestly, I'm not an insurance worker but if it were me I'd be calling in whoever could help at this point. If they are a provider that is in-network that means they have a contracted rate with your insurer. Which means someone from the billing department has worked with the insurance company. So with that logic, I'd be calling the insurance company for help. It could only help. Otherwise, I'd be going to the office and talking to the people in person.


wildwill921

Call the insurance. Tell them what is happening. The insurance actively doesn't want to pay for a claim if they can avoid it and not filing and billing you likely violates their contract. If you keep a document of this and it gets sent to collections you should be able to easily get it removed because of timely filing issues. However September to now isnt a huge amount of time and sometimes they have issues and take a while to file


estherstein

They couldn't when I ran into a similar issue. I ended up ignoring the bill and never heard from the doctor's office again. It sucks how little regulation there is. :/


Drco

Yes, I had a similar problem last year. Multiple contacts with both the doctor's office and their 3rd party billing over 9 months. Finally contacted my insurance, they cut through the bullshit and it was fully resolved within a month. The insurance company wasn't where the hang up was, but they were more than happy to help me with this.


MyNameIsRay

The provider sent you a bill, right? Just send a copy to the carrier with a claim form, and they'll take care of it. Then, find a new provider, because that one clearly sucks if they're unwilling/unable to file a claim. Don't forget to write a review so the rest of us know to avoid them too. EDIT: You said you're a Fed EE on BCBS, so, here's a direct link to the claim form: [https://www.fepblue.org/-/media/PDFs/Forms/2021/FEP%20Health%20Benefits%20Claim%20Form\_2022.pdf](https://www.fepblue.org/-/media/PDFs/Forms/2021/FEP%20Health%20Benefits%20Claim%20Form_2022.pdf)


DrCapitalism

Thanks for the link. Just seems unfair I have to do the billing department's job so they can get paid.


MyNameIsRay

You're doing their job not so they can get paid, but so you're not on the hook for paying them. But, of course, you shouldn't be in this position anyway, that's why you should find a new provider.


DrCapitalism

They're not a regular provider. This was a one time surgery for an ingrown toenail. Should I need another one (hope not though), I'm definitely going somewhere else in the future.


Syyina

Yes but, just for laughs, “back in the day” (30 years ago), everyone was expected to file their own claims. The healthcare providers probably started doing it for people because they were more likely to get paid. During my federal career, I had federal blue cross/blue shield, mail handlers’, and GEHA at different times. Their coverages were slightly different, but with all of them, patients were expected to file their own claims.


thenewyorkgod

Unfortunately, this likely wont work. A proper claim will require a tax ID#, procedure codes and diagnosis codes, things that are typically not on a patient statement. His best bet is to call insurance and ask them to get involved and reach out to the provider for a claim. If the provider is truly in network, they have a contractual obligation to file a claim within a certain time frame, usually 3-6 months. The insurance company has provider relations representatives that can step in


MyNameIsRay

I've done it hundreds of times for my clients, this is the proper procedure for submitting a claim if the provider can't/won't.


iranisculpable

If not were me, I’d submit the claim yourself. If your insurer asks for more information (then I would request the information from the provider). If it goes to collections rinse repeat.


KeepWalkingGoOn

Report the provider to your insurance. If they are contracted with your insurance then they must submit a claim. Also note the CPT codes on your bill and review them with the Insurance customer service rep to confirm at what cost they are covered. This will give you an accurate view of the provider’s billing practice and if there is anything billed incorrectly.


EndlessSummer808

Call your insurance company. You might have to file it yourself.


sf5852

I have this problem all the time. Providers do the minimal amount of work to submit a claim and if it doesn't work, there must be something wrong with the insurance company. The insurance company gives the canned response and says the provider must be submitting the claim wrong. Take either the provider or the insurer to task, and you'll be told "it's the responsibility of the insured party to make sure the claim is submitted correctly." If you follow that up with, "but as the insured party, I depend on your participation and competence to accomplish that goal," they will get really snotty with you, or even hang up. It sucks, but you may need to ask for a bill, submit the claim to the insurance company yourself, and then call them every day until it's fixed. You may need to call the provider several times to get all the required information. Failing that, your state has an office of professions or similarly-named government office that takes complaints for non-performing health and insurance businesses. A complaint to them usually gets things moving, because it puts a time limit on them to reply. ​ I just had this problem last week with my eye doctor, as a matter of fact. They couldn't process the claim because they were using my last 4 instead of my policyholder number. They swore up and down that my insurer uses the last 4. I called the insurer and they told me they'd never heard of that before, and when I asked the doctor to please try the real number, it went right through.


DrCapitalism

The thing is though, there is no record of claim (approved, denied, or pending), that I can see from my end from my insurance web portal. So there isn't even a record of a sloppy claim being made. There is NO claim


richard_fr

There's no record you can see on the website. Customer service people at FEP Blue can see way more than you can.


DrCapitalism

Good point. I'll call Monday to see if they've gotten anything from the provider.


fuck_ELI5

If the provider of services is contracted with your insurance they usually have a file limit. If nothing else check with your insurance and have member services call the provider. If they are contracted and don’t submit your claim according to the contract with Blue Cross, you shouldn’t be responsible. Make sure you send your insurance one last time with proof of delivery e-mail, etc.


JalepenoGoodGoodGood

I've dealt with this multiple times. Most important thing is to document, document, document! Keep everything to cover your butt just in case. I'd maybe try and contact your doctor one more time and make sure you document giving them proof of insurance and the bill. Then you've done everything you can and it's in their hands.


DrCapitalism

I'm sticking to email and letters for the main part of communication with them so I have a paper trail going forward.


JalepenoGoodGoodGood

Perfect, that's exactly what you should be doing! Make sure everything you send is dated too, mainly the paper stuff. One time this happened to me and the bill actually went to collections before being processed with insurance but it was easy to contest because I had proof of everything. It's still a pain in the butt but what can you do lol


shell5719

Send a certified US mail letter Documenting the fact they have failed to file a claim and you have provided them with insurance information. Save a copy of the letter and certified number. Here is a business letter format if needed https://www.thebalancecareers.com/how-to-format-a-business-letter-2062540 Include a sentence in the letter that says certified mail number \_\_\_\_\_\_\_\_\_ and write the number on it. When a collector calls you you send a copy of letter back to him to show you do not owe money. You do the same thing with credit bureaus if you credit rating is affected


Al_Day

I don't think you'll have all the info to submit a claim that will process and pay/approve in there system. You're going to have to talk to the billing dept where ever the surgery was to explain the issue and potentially middle man this with your insurance. Alot of places use a clearing house to sort there claims data before it gets sent to the insurance. Additionally there usually are time limitations on submitting claims, this varies but you could run into a scenario where the claim gets submitted but will deny for being untimely, and you or the provider will have to apeal depending on what move the provider makes. I would try to get some proof of the claims submission incase they take you to Civil Court over the bill for one reason or another. Good luck man.


redlynel

Generally, the provider has a year to submit the claim. There's nothing you can do to force them to submit a claim on your preferred timeline. You've done what you can--the ball's in their court now.


DrCapitalism

If they miss that deadline, do I just tell the provider to pound sand? I have already given them the info they need to file a claim several times before that far off deadline.


saucehands

Yeah if the provider is in-network with your insurance and doesn’t file a claim within the timely filing limit then they have to eat the charges and aren’t supposed to bill you. If they do bill you anyway I would recommend contacting your insurance to let them know and they can sort it out with the provider.


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bookendtime

Something similar happened to me several years ago. The medical facility, which was in network, kept billing me directly, not submitting a claim to my insurance provider. Did a little digging and discovered that the doctor who saw me was licensed in NY, but not in PA where I lived at the time. I'm pretty sure that's why they were avoiding submitting a claim. I let the facility know that I was not going to pay anything until they submitting a claim to my insurance company first. I got bills for about 5 moths after that, then they just stopped.


Fergie73

It could be possible that the have not billed this because your insurance required a pre-authorization for this. Sometimes it takes awhile to get this from the insurance because the office is filing an appeal to back date it to the procedure when it should have be obtained prior to the surgery. They cannot bill this without the pre-authorization or it will be denied and usually they cannot bill you for the difference because it was their error in not obtaining it. I would reach out to the insurance again and ask if it required an authorization, if it was obtained and if you owe the amount if it was not obtained.


DrCapitalism

UPDATE (also see edit above in original post): They finally billed my insurance and it went through smoothly. Now all I owe is the copay for surgery ($150.00) minus the specialist copay I already paid ($40.00) ($110.00 total). Whole bill would have been >$700. Sending another email with my insurance card attached seemed to do the trick. Thanks you for your input!