by simple0ne1 » Wed Nov 04, 2009 10:42 pm
I hope someone can help.
My father went in for a surgery last April at his old company. My father changed companies a month later. The doctor was paid for their services while the anesthesia services (billed at ~ $5,700) were not.
Insurance Company A said they received the claim and was processing it and erroneously deleted the claim. Since then, my father's old company has changed its health insurance carrier to Company B; which removes Insurance Company A access to the old company's bank account information to pay the claim.
The anesthesia office was contacted and told us we had to either have the new insurance pay the claim, or we would have to pay the claim. After speaking to them for a while, they said that if we could not have an insurance carrier cover the claim, we would have to pay $500 for the services. Yes I know its a lot cheaper than $5,700, but I would like my father not to pay anything at all.
After getting off the phone with Insurance Company A, they stated they cannot do anything at all even though it is their fault the processing of the claim was deleted. They said we should try to get my father's old company to pay the $500.
Can I request for Insurance Company A to pay the $500 because it was their fault in deleting the claim? Small Claims Court? What are my options? Course of action?
Thanks,
Rob
My father went in for a surgery last April at his old company. My father changed companies a month later. The doctor was paid for their services while the anesthesia services (billed at ~ $5,700) were not.
Insurance Company A said they received the claim and was processing it and erroneously deleted the claim. Since then, my father's old company has changed its health insurance carrier to Company B; which removes Insurance Company A access to the old company's bank account information to pay the claim.
The anesthesia office was contacted and told us we had to either have the new insurance pay the claim, or we would have to pay the claim. After speaking to them for a while, they said that if we could not have an insurance carrier cover the claim, we would have to pay $500 for the services. Yes I know its a lot cheaper than $5,700, but I would like my father not to pay anything at all.
After getting off the phone with Insurance Company A, they stated they cannot do anything at all even though it is their fault the processing of the claim was deleted. They said we should try to get my father's old company to pay the $500.
Can I request for Insurance Company A to pay the $500 because it was their fault in deleting the claim? Small Claims Court? What are my options? Course of action?
Thanks,
Rob
Posted: Thu Nov 05, 2009 06:23 am Post Subject:
It sounds as if your father's old company has a self insured plan and they switched administrators. I've been involved from the claim payment side of these about 10 times for both large and small companies. They were handled different ways, but claims were always paid. Your father's company should allow Company A to pay the claim or Company B should be able to pay the claim....it really depends on how they set it up. (It sounds as if Company B is handling everything).
I know it sounds fishy that it is not being paid because your father left his company, but I am sure he is not the only person at the old company that had claims hanging out there. Company B must have the authority to pay older claims. You are going to have to start with the HR department at your father's old company to see where this claim should be sent.
If it is a self insured plan, Company A has no control over not being able to pay the claim. Start with the HR department.
Posted: Mon Nov 09, 2009 03:05 am Post Subject:
Thanks for the response!
Yes Insurance Company B is taking care of everything now and Insurance Company A said they have don't have access to the accounts so they can't do anything.
I'll be contacting the HR department tomorrow and hopefully things will go smoothly.
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