General Category > General Questions

Claim Pending - Requesting information from Patient

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kristin:
I know of no way around COB issues. That is between the patient, and their insurance companies, and only they can fix it. We see it a lot when patients first switch to Medicare, and Medicare still thinks they have commercial insurance as primary.

PMRNC:
Doing Ped's we have to deal a lot with COB requests pending at carrier, so we actually will ask the parent when they come in if there are any changes to their carriers or employment, if we can catch a potential COB pend before it happens it's better. Also if you contact the patient and ask them "We see your insurance carrier is holding our charges for information they requested from you, can we help you with this so you don't have to come out of pocket for the whole bill?"  That usually does the trick. We just get lucky to catch a few before it happens and we have a form we give to patient to complete and we send in with their claim if they changed employers. contains all info carrier would need to check other benefits.

barcafan1990:
I always assumed that insurance carriers pended claims (for COB) as a trick to not have to pay it until the first time a provider submits a claim to them. Not then do they conveniently verify that they should be paying. And as Kristin said I didn't think there was a way around this. But Linda, I am curious to know more about the form that you use to proactively "help" the insurance carrier with COB. Could you share what other details it includes that is not already included on the claim? And how do you attach these electronically to claim batches, or are you mailing these in via paper?
Thanks!

PMRNC:

--- Quote ---I always assumed that insurance carriers pended claims (for COB) as a trick to not have to pay it until the first time a provider submits a claim to them. Not then do they conveniently verify that they should be paying. And as Kristin said I didn't think there was a way around this. But Linda, I am curious to know more about the form that you use to proactively "help" the insurance carrier with COB. Could you share what other details it includes that is not already included on the claim? And how do you attach these electronically to claim batches, or are you mailing these in via paper?
--- End quote ---

Depending on patients plan, for dependents, they will require info once or twice year. For COB info they pend the spouses claims and dependents if the plan follows the bday rule and the insured's bday is after the spouses. If the spouse is not working, nothing further is needed. If the spouse is working they require information from the spouses employer about other coverage available. If another carrier has primary responsibility they of course won't pay the claim until the primary plan has been billed. Some carriers won't pend and will pay and issue an ROR (right of recovery) statement which says they have a right to recoup the funds later.  The form the front staff uses is basically just the first step, requesting the spouse's employer information and such. IF the spouse has other coverage and they can show it, then we can just bill primary and send in the info to the other coverage we had on file.

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