C
Candace29
Guest
What is the name of your state? Georgia
I posted about this under malpractice, so if this is considered a double post I'm sorry. My mother is in a nursing home because of a car accident she had 15 years ago. They have health insurance through the GA Dental Association. Three years ago the group switched to BCBS. The nursing home filed for two months after the switch. The claims were denied for no preauthorization. I am assuming that the nursing home didn't bother to appeal and just switched my mother's account to self pay. In Feb 2003 I went to the nursing home and got everything needed to file to BCBS. I filed everything and they didn't want to accept handwritten claims from patient, they wanted printed claims from provider. So I did get the nursing home to print the claims for me. When the EOB's came back it said that the Provider is responsible for all charges and the patient is responsible for 0. BCBS said the reason for that is because the nursing home had a provider contract and this was outlined in there contract. Well my Father has already payed for all these charges. I had a meeting with the nursing home and brought the EOB's, cancelled checks,and the bills which were sent to my father.
I need some advice on what else to do. I sent everything to the insurance commissioner and they sent a letter and said they forwarded it to the dept. of human resources. Can they help in this situation? Is there anyone that can help? Are the EOB's legal? How do I go about getting his refund?
Sorry so long. I will appreciate any advice and thank you in advance.
I posted about this under malpractice, so if this is considered a double post I'm sorry. My mother is in a nursing home because of a car accident she had 15 years ago. They have health insurance through the GA Dental Association. Three years ago the group switched to BCBS. The nursing home filed for two months after the switch. The claims were denied for no preauthorization. I am assuming that the nursing home didn't bother to appeal and just switched my mother's account to self pay. In Feb 2003 I went to the nursing home and got everything needed to file to BCBS. I filed everything and they didn't want to accept handwritten claims from patient, they wanted printed claims from provider. So I did get the nursing home to print the claims for me. When the EOB's came back it said that the Provider is responsible for all charges and the patient is responsible for 0. BCBS said the reason for that is because the nursing home had a provider contract and this was outlined in there contract. Well my Father has already payed for all these charges. I had a meeting with the nursing home and brought the EOB's, cancelled checks,and the bills which were sent to my father.
I need some advice on what else to do. I sent everything to the insurance commissioner and they sent a letter and said they forwarded it to the dept. of human resources. Can they help in this situation? Is there anyone that can help? Are the EOB's legal? How do I go about getting his refund?
Sorry so long. I will appreciate any advice and thank you in advance.