Getting the doctor paid

[greatnecksimon]

What is the name of your state? New York.

The plastic surgeon for whom I work is considering legal action against an insurance carrier that repeatedly denies claims as "non-timely." Our records document timely filing but the carrier doesn't accept our aging schedule. Often a claim is filed 6 or more times, but the carrier claims not to have received a single filing within the timely filing period, and unless we have receipts to prove electronic submission, the carrier refuses to pay. In cases where I CAN present proof, the carrier usually denies the appeal as non-timely. These are clean claims that should have been paid. The Dept. of Insurance won't involve itself in what it considers to be "administrative issues." I am considering bringing suit in small claims court but I don't know if this is a good remedy, or if such a suit would even be acceptable. The doctor renders service in good faith; he is entitled to be compensated. If he is a participating provider, he is enjoined from billing the patient so if the carrier denies the claim, he doesn't get paid anything for his efforts. Can anyone suggest a means of compelling an insurance carrier to pay?

[MissAnnie]

Have you contacted the network provider rep for the ins company? you can contact provider services and ask for the name and phone# of the provider rep for your county. Sometimes they are able to get these claims processed. Personally, this tactic has worked for our practice with BCBS, Mamsi and even Medicaid.