Ok Come on man this cant be reality??

[scagnt83]

No I have not yet had any word that anything was resubmitted, only this i know is the claim was submitted without the preauth attached

Oh. Then tell the facility to resubmit the claim with the autho letter. Should be a non-issue if you do it that way.

 

[vic120]

Oh. Then tell the facility to resubmit the claim with the autho letter. Should be a non-issue if you do it that way.

We did

all we are told and its a long wait for resposes

we are looking into it

that is all they will say at this point and do not respond right away or at all sometimes

 

[scagnt83]

We did

all we are told and its a long wait for resposes

we are looking into it

that is all they will say at this point and do not respond right away or at all sometimes

Show up in person. Tell them you are going to pursue legal council if they do not submit the claim in a timely and accurate manner. Dont leave until they submit it.

 

[vic120]

Show up in person. Tell them you are going to pursue legal council if they do not submit the claim in a timely and accurate manner. Dont leave until they submit it.

Ha its nationwide in Columbus

There is only one person who does billing they tell me and she is only accessible by email

I can call but only to VM

 

[LeeV]

I am not getting this, Ok the carrier is right what does that mean

Am I wrong and responsible to pay provider??

Or is the provider responsible for THIER mistake?

I am really confused because If I did not submit something right and caused harm to one of my clients I would be held to the cross

Why are there providers able to just take advantage of people?

Should not the provider be the one to suffer loss for their mistake??

They were the one who submitted things wrong to the carrier

I mean seriously what other industry would they be off the hook legally speaking?

I am really struggling on how or why this falls on me

We did by the way explain everything to the carrier and they said all they can say is file an appeal and we did and it was denied

Based on what you have provided in this post, I do not believe you are at fault. It is the providers' responsibility to submit the preauthorization with the claim.

What I mean by "the carrier/administrator" is right is that they adjudicated the claim as written in the plan documents. If the plan requires a preauthorization and a claim is filed without one, the carrier/administrator will pay as if no preauthorization was provided. This is their only option.

Yesterday I suggested that you contact the customer service dept of your plan, explain to them what happened, and ask how you can submit to them the preauthorization. Have you done this?

 

[vic120]

Based on what you have provided in this post, I do not believe you are at fault. It is the providers' responsibility to submit the preauthorization with the claim.

What I mean by "the carrier/administrator" is right is that they adjudicated the claim as written in the plan documents. If the plan requires a preauthorization and a claim is filed without one, the carrier/administrator will pay as if no preauthorization was provided. This is their only option.

Yesterday I suggested that you contact the customer service dept of your plan, explain to them what happened, and ask how you can submit to them the preauthorization. Have you done this?

Yes they said the provider was supposed to submit it with the claim and that is all they would say

We asked if we can do it they said no it is the provider who submits the claim and it is they who have to submit it

so how do you feel I am at fault here

I am really trying to understand how in the world I can be responsible

 

[LeeV]

I called your carriers' customer service department. They want you to call the customer service department and explain the situation, they can reach out to the provider for you.

 

[vic120]

I called your carriers' customer service department. They want you to call the customer service department and explain the situation, they can reach out to the provider for you.

Strange they do not say that to us, they told us to do an appeal which we did and was denied a 2nd time

My Wife has spent countless hours on this

 

[goillini52]

Strange they do not say that to us, they told us to do an appeal which we did and was denied a 2nd time

My Wife has spent countless hours on this

I repeat....tell the provider if they want to get paid, they have to file the claim properly.