by Guest » Wed Sep 25, 2013 06:08 am
My insurance company is supposed to pay 80% on my claims, and I’m responsible for the rest. This past year, they have have kept on paying only 70%. I didn’t realize this until I checked the statements. When I reached out to them regarding the errors, they reprocessed the claim and made the necessary adjustments. But these things have occurred many times and frequently. When I asked them about the reason, they told me that it’s because of the way the providers were billing for the services/processes.
When I asked my state’s Consumer Affairs Services about this, they told that it is up to individuals to check their statements to make sure that everything is going ok. Isn’t there a way to compel the insurers and providers to bill in the best possible way?
When I asked my state’s Consumer Affairs Services about this, they told that it is up to individuals to check their statements to make sure that everything is going ok. Isn’t there a way to compel the insurers and providers to bill in the best possible way?
Posted: Wed Sep 25, 2013 08:14 pm Post Subject:
Isn’t there a way to compel the insurers and providers to bill in the best possible way?
It's called a gun. The bigger the better. But that may also lead to other problems.Why would you complain to "Consumer Affairs" about an insurance matter? Complain to the Dept of Insurance in your state.
Posted: Thu Sep 26, 2013 12:00 am Post Subject:
I can't say what happened but I'm guessing that the medical provider coded the bills incorrectly which moved the treatment to that of what should be paid at 70%. Why would the provider want to get paid less from the health carrier? If the mistake happens a lot, keep reporting it to correct office.
(Consumer Affairs in FL took over the Dept of Insurance. I'm guessing that perhaps this took place in FL).
Posted: Thu Sep 26, 2013 03:35 am Post Subject:
Consumer Affairs in FL took over the Dept of Insurance
No kidding. That's a crazy state to do business in anyway. An insurance agent needs to be licensed in each county, not one license for the entire state.Posted: Thu Sep 26, 2013 04:49 am Post Subject:
Thanks a lot Max and tcope!! :)
Posted: Thu Sep 26, 2013 05:04 am Post Subject:
An insurance agent needs to be licensed in each county, not one license for the entire state.
They only need one state license, a 220 license.Posted: Thu Sep 26, 2013 12:10 pm Post Subject:
Actually, it was a misstatement on my part. It is one license, but one must be "registered" in each county in which he/she wants to do business. Additionally, Florida's Division of Insurance is not in the Department of Consumer Affairs, it is within the Chief Financial Officer's Department of Financial Services.
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