S
shockman1975
Guest
What is the name of your state?
Ohio
One year ago my daughter had tests done at the children’s hospital, in which the hospital was able to correctly file the claim with the insurance (an HMO) and receive payment for its portion. However the imaging provider for these tests, which is a different entity than the hospital, never did file a claim with the HMO. Repeated calls and letters with the proper insurance information to the imaging provider did nothing, they claimed that it was denied by insurance. I contacted my insurance and said that they had no record of the claim and told me to tell the imaging provider to file the claim properly. So the circle continued..
Finally I found a form (found only by extensive searching of the HMO website) in which I could file the claim myself and within a few weeks I received the Explanation of Benefits showing the contracted amount being paid. However at this time the imaging provider sends the bill to collections and it shows up on my credit report.
-Is a health care provider required to file a claim with an Insurance Company?
-Does an Insurance Company have to send an Explanation of Benefits explaining the payment or why it was denied for every claim received by a provider?
Ohio
One year ago my daughter had tests done at the children’s hospital, in which the hospital was able to correctly file the claim with the insurance (an HMO) and receive payment for its portion. However the imaging provider for these tests, which is a different entity than the hospital, never did file a claim with the HMO. Repeated calls and letters with the proper insurance information to the imaging provider did nothing, they claimed that it was denied by insurance. I contacted my insurance and said that they had no record of the claim and told me to tell the imaging provider to file the claim properly. So the circle continued..
Finally I found a form (found only by extensive searching of the HMO website) in which I could file the claim myself and within a few weeks I received the Explanation of Benefits showing the contracted amount being paid. However at this time the imaging provider sends the bill to collections and it shows up on my credit report.
-Is a health care provider required to file a claim with an Insurance Company?
-Does an Insurance Company have to send an Explanation of Benefits explaining the payment or why it was denied for every claim received by a provider?