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.
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.