If the patient's policy is by CALENDAR year, the date of service should be applied to the benefit year of the date of service. You may need to verify that their benefits don't renew in an odd month. We have many teachers who renew on 7/1 of each year, not Jan. 1. A phone call should get your question answered.
The Value Options rep I spoke with verified that the policy was a calendar year policy. She just said that VO applies the claim to a benefit period based on the day VO received the claim, not the date of service. So, according to this rep, date of service 12/21/11 counts towards the 2012 policy because they received in in 2012.I have NEVER heard of anything like this before. Is this something VO can do? It seems very wrong to me, but that's hardly any leverage to go on.Thanks all.
Quote If they are however counting the visit towards the benefit visit max for 2012 that's ok, yes carriers can use date of receipt of claim, at the end of the year if they exhaust the benefit, they may cancel out the prior year visit or two. I didn't quite understand this bit. Are you saying if the patient exhausted her 2011 visit limit, the carrier could use date of receipt of the claim to apply it to the 2012 visit limit? Cause that would be fine with me if this were the case! However, in this case, the patient has unlimited visits (for both 2011 and 2012), so I don't think this is the issue here.There's supposed to be a VO supervisor calling me sometime this week, so I'll let y'all know what she says! Thanks!
If they are however counting the visit towards the benefit visit max for 2012 that's ok, yes carriers can use date of receipt of claim, at the end of the year if they exhaust the benefit, they may cancel out the prior year visit or two.