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Insurance contacts patient

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ste:
I have been doing the billing and proudly continue to do so. I don't suspect any wrong doing on my part or the provider's part. I have looked into recent claim activity on-line and found a claim with "payment is denied when performed/billed by this type of provider." I also found another claim on a different family member with a later DOS that has been accepted and "finalized for payment" although a check has not yet been issued.
I reviewed the policy booklet and specialty is neither included as a covered benefit, nor is the specialty mentioned in the general exclusions section. When I verified benefits 10 months ago the specialty was a covered benefit for office visits, although the disclaimer on benefits verifications throws that defense out with the bath water.
I guess my biggest fear is that the insurance company will say, "No. This specialty is not a covered benefit. So, give us back all the money we have paid you thus far."
Can an insurance company do this? And yes, I will call them on Monday.   

Michele:
I'm actually surprised that they were paying.  Please don't interpret this incorrectly.  I'm not saying that I personally do not think that this provider does not provide a very good service to patients, I'm saying in my experience Insurance Carriers do not usually cover these types of providers because they consider the treatment not proven.  It is a possibility that they could come back and state that the claims were paid in error, and request the payments back.  :(  I've seen it happen. 

But Congrats on the 18 accounts!   ;D

Michele

PMRNC:

--- Quote ---I have been doing the billing and proudly continue to do so. I don't suspect any wrong doing on my part or the provider's part. I have looked into recent claim activity on-line and found a claim with "payment is denied when performed/billed by this type of provider." I also found another claim on a different family member with a later DOS that has been accepted and "finalized for payment" although a check has not yet been issued.
I reviewed the policy booklet and specialty is neither included as a covered benefit, nor is the specialty mentioned in the general exclusions section. When I verified benefits 10 months ago the specialty was a covered benefit for office visits, although the disclaimer on benefits verifications throws that defense out with the bath water.
I guess my biggest fear is that the insurance company will say, "No. This specialty is not a covered benefit. So, give us back all the money we have paid you thus far."
Can an insurance company do this? And yes, I will call them on Monday.

--- End quote ---

I still have not seen any posts to indicate what type of services are being provided...but when I meant suspicion of fraud or a problem.. I am referring to the fact that the insurance company spoke to the patient..at that point there should be some action on your part not to submit claims until you get to the bottom of it because IF there is any wrong doing, you could hold some liability.. Just CYA is all I'm saying.


--- Quote ---The head of the household recently received a phone call from the insurance telling him that this particular provider is not a doctor, he and his family shouldn't be seeing this provider, the provider isn't covered, and on and on. The insurance went to great lengths to dys the provider and did so in a rather threatening manner.
--- End quote ---

That's the part that bothers me with this and again, I don't know what services are being provided, etc.  It's possible this could be a fraudulent license....it just would not sit well with me to send another bill until I got to the bottom of that.

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