Ok, since not ERISA, you pretty much have exhausted with the State Dept / AG. The Customer service rep's are covered by their disclaimer that " benefits quoted are not a guarantee...etc., etc." The services are "NON" Covered as you found out with even the state dept of insurance. At this point, what I would do is bill the patient as there is nothing else you CAN do. In meantime you can let the IRO play out, I would say to cover the practice's butt and make sure patient understands you are doing this FOR them but bottom line they are responsible for out-of-pocket.
I'm not sure what the doctor is planning to do regarding billing the patient. I relayed the message from the AG that he needs to be thinking about that possibility. I guess he's waiting for the IRO to play out before deciding next steps.
First of all, congratulations on getting them overturned! Good work!So basically they did overturn and pay but the provider does not want to accept the amounts, correct? If the provider is out of network they can bill the patient for the amount above what the insurance carrier allowed. I'm not familiar with CollectRX in particular but it appears they are a revenue cycle management company. Since you already did the work of getting the claims overturned it seems like you might not need a full service like them. Have you tried billing the patient yet? I would try billing first on my own. If the patient indicates they aren't going to pay, or doesn't respond, then I would do something more like collections. We use a soft collection agency that has great results.
I get it. Just curious, why will the provider not use a collection agency? I'm assuming it's for the same reason many don't and it's that they don't seem to be effective. We experienced the same thing for many years. We used many different collections agencies but not one had any kind of results. It was a total waste. Honestly I wasn't sure how they stayed in business. They only got paid on what they collected and for us it was always nothing!But we have found an agency that has amazing response rates. They are soft collections and are kind of in between regular billing and collections. They have a couple of different options including Rapid Recovery and Accelerator. I believe their collection rate under Accelerator is in the 90% range! THey are great to work with. Full disclosure: I get nothing for referring people to them. I just truly love the results we get and our rep (who can handle any account in the US) is wonderful to work with. The name of the company is Transworld and our rep is Richard Neary. I can get anyone his contact information if desired.