Has anyone ever actually filed a complaint with their state’s Dept. of Insurance? I am in NY in case anyone has specific advice about NY.
Although the insurer is in NJ. How would that work across states?
I have a peculiar situation. I submitted a behavioral health claim to a small union insurer using cpt 90791. We got a letter back that this is an invalid code and unprocessable?!?! This code has been valid since Jan 2013. The claim was submitted for a Nov 2013 dos.
I have called multiple times and been told that they cannot process the claim because 90791 is not in their “system.” I was told that I should resubmit it with a different code. The one rep there is quite unenthusiastic about her job. They have paid the subsequent 90834s that we have billed. I cannot call for claim status as they refuse to enter it into their system! A supervisor is never available to talk. I have faxed the claim over 4 times and requested that a supervisor call me back.
Since this union is part of PHCS/Multiplan and the provider is par with them, I attempted to file a complaint with them, but they were not very helpful and said I needed to pursue this myself.
I am not sure how far I should go with this, as behavioral health is a sensitive specialty regarding patient privacy, etc. I need to check with the provider, but my instincts are to speak to a Union head and/or get the patient involved.
But, just curious, has anyone ever filed a complaint with the Dept. of Ins? How did that go?
All input and comments welcome and appreciated!