AboutMichael Higgins Expertise All questions pertaining to health insurance, whether group, individual/family, student, child-only, COBRA, HIPAA, Portability, dental. No expert knowledge in areas such as life insurance, disability, workman's compensation, auto, etc.
Experience 27 years as owner of health insurance agency, primarily dealing with Blue Cross Blue Shield of Arizona.
Education/Credentials College, Business Administration.
Question The billing clerk (outsourced) for my rheumatologist continually submits incorrect claims to my health insurance carrier (Anthem BCBS PPO in Virginia), causing my account to remain unpaid. This has been going on since last year! I've spoken to her several times to try to get it straight--all to no avail. I'm at my wits end.
Two claims have not been paid: one from 4/30/08 and the second claim is from the first quarter of 2009.
Here's my question: if the billing clerk doesn't file the claims correctly and the doctor eventually bills me personally, what recourse do I have? They are aware of the problem but don't seem to want to deal with it. Shouldn't the burden be on them to get their own bills submitted and paid in a timely fashion?
I appreciate any help you can give. I cannot (and should not) pay hundreds of dollars for office visits that the insurance covers. Thank you for your time.
Answer Hello Dianne:
Your state may have different laws and protections for the insurance purchaser, but my educated guess is that you are responsible for the bills whether you have insurance or not. That said, I'm sure if the doctor herself or himself learns of your ordeal something will get done. The doctor may say that a separate company handles the billing, not their office. Ask for a contact name if this is the case. Also have your insurance company do what they can by contacting the claims department. Here are two links from Anthem, http://www.anthem.com/provider/me/f5/s2/t0/pw_a032002.pdf
www.anthem.com
In conclusion, I would start with a call to Anthem claims, then to a higher up at the doctors office if BCBS doesn't straighten things out for you.
