Payments > Insurance Payments

Incorrect Insurance Verifications

<< < (2/2)

midwifebiller:
Oops, missed this one. Sorry, Linda--I wasn't ignoring you!

Our providers are out-of-network, so they are not bound by any contract.  The appeal goes something like this:

We are in receipt of your denial for services rendered to [member's name] for reason of: provider type not covered. We request an appeal of this decision based on the following:

On [date and time], we called your office and spoke with [their reps name], who clearly stated midwifery care is a covered benefit under Mrs. [name]'s plan.  A written record of this conversation is enclosed. It was with this information that Mrs. [name] chose to continue care with us. It was with this information that we submitted claims in good faith and did not bill your member for that portion of our care.  We have rendered quality care, submitted claims per your specifications and have done everything necessary to ensure claims are processed for payment.  We expect you to honor your agreement with your member, Mrs. [name], by covering our services at the stated rate. 
Please reprocess the claims for payment.

Most of the time, this is all it takes to get the claims to reporcess. Occasionally they will come back and tell us the rep mis-quoted benefits, and they are so sorry, but midwives are still not covered.  We then send a second letter and have done three-way phone calls with the member and a supervisor at the insurance company to listen to the recording of our initial phone call where benefits were verified.  We hold them to the benefits quoted and have only been unsuccessful once or twice.

Navigation

[0] Message Index

[*] Previous page