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Incorrect Insurance Verifications

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platmedrec1:
I work with a chiro and we do IVs on every patient.  Recently we have had two that when the claims processed are not even in the ballpark with what we were quoted and thus quoted the patient.

1. We called 10/08/10 and were given 2009 plan benefits because her plan started over 9/15/10.  Pt was mad at us because we quoted from these benefits that she would be resp for 20% and now she has a balance that she wasn't prepared for.

2. We called 10/2/10 and were quoted no deductible and $15 copay per visit, and when I called today because her claims are going to deductible, I was told her benefits are $300 deductible 80/20 up to $1k - not even close to what we were told.

We realize that benefits quoted are not a guarantee and we also have a disclaimer on our financial policy that basically we are only as good as the info presented by their ins and ultimately it is the pt resp to know their benefits, yada yada.  But that doesn't help us from looking like idiots that can't do our jobs and it doesn't keep the patient from having a huge balance.  We provide the IV to the pt so they have info to make their tx choices, but getting wrong info from the payer is driving us crazy.  Do we have any recourse?  I did speak with a supervisor on both occasions, but got a sorry 'bout your luck attitude.

Has anyone else ever had this issue and do you have any suggestions?

Cara

DMK:
I have had this happen many times.  Chiropractic is treated differently than a standard medical visit by many insurance companies.  ALL you can do is write down what was quoted, or if you check online, print the page.  And tell the patient exactly what the insurance company tells you "benefits quoted are not a guarantee of payment".

Also, be aware that in network and out of network benefits are usually vastly different.

Ultimately, the patient is responsible to know their benefits.  If their policy changes mid-year, they should be aware of that.

Sportsmom:
I print out the benefits right off NaviNet and share with the client. When you call the ins they don't understand chrio benefits. I get it a lot from BC/BS of NJ.

midwifebiller:
This happens to us frequently. When we call and verify benefits, we fill out a VOB form (our own), complete with the date, time of call, and the name of the rep we spoke with, along with all of the qustions we ask. If claims come back processed not as we were quoted, we send an appeal letter and attach a copy of the completed VOB form. 90% of the time, the claims are reprocessed correctly.

If an appeal is not successful, we ask the member to take the completed VOB form to their HR department--that usually results in claims reprocessing correctly.

~Kelli

PMRNC:

--- Quote ---This happens to us frequently. When we call and verify benefits, we fill out a VOB form (our own), complete with the date, time of call, and the name of the rep we spoke with, along with all of the qustions we ask. If claims come back processed not as we were quoted, we send an appeal letter and attach a copy of the completed VOB form. 90% of the time, the claims are reprocessed correctly.

If an appeal is not successful, we ask the member to take the completed VOB form to their HR department--that usually results in claims reprocessing correctly.
--- End quote ---

Hi Kelli, I am curious..what types of appeals are these? I just ask because (please don't take this wrong) I find it hard to believe you can successfully appeal 90% of verifications processed differently than quoted  ??? ???

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