Health insurance stalling & incorrectly filing claims

[gregp]

Hi, my wife and I live in California. We racked up about $10,000 dollars in medical bills. We have medical insurance
that should cover about 90% of our bill. Our problem is that we have a out of state provider so when my doctor's office submit's a bill they go through a California office then at that point get filed incorrectly or lost.I have even had a person at the California office admitt that they were responsible for the problems. My doctor's office has been having this problem for over a year now! They are looking at me to pay the bill. Is there anything I can do?
Thanks,
Greg

 

[ALawyer]

Contact the head of the insurance company, and explain the problem and demand he or she figure out a way to resolve iton past and future claims. Contact the state insurance commissioner r state and its state also.

 

[Krystalbubbles]

have they tried faxing it to them?

I used to work for a health insurance company. The policy they had was to tell callers to fax the claim in if it was over a year old. When they recieved it, it was treated as a 'hot issue' and regardless of the time frame, dollar amount, or medical neccessity, if you were covered at the time, it would be paid. I don't know if all insurance companies have this policy, but it might be worth a try? All you need to do is call, or have the doctor call in on the matter and have the party ask if they can fax it in since it is becoming a problem that needs to be ratified quickly. Usually, they will give you the fax number of the correct office to send it to. Sometimes they might give you the run around though and say they can't accept faxes, if that happens, ask to speak with a supervisor and if they do the same, keep going up till you get the information you need. Don't let them push you around, but don't get upset either. They do warn you that the calls can and will be monitored, this is for your protection as well as theirs.

Bubbles

 

[gregp]

Thanks for the advice

Thank you so much for your advice! I talked to the head of the organization and threatened to inform the State insurance commissioner about their practices. I now at last feel confident that my claims are going to be taken care of promplty.