Wiki Insurance Commission

[knperry]

Has anyone ever had to involve the insurance commission in order to get a claim paid? I've been trying to contact someone, who I was told was the boss for processing claims, since April of this year. This person will not call me back. I know she has received my messages because sometimes when I call the voicemail is full but I'll call again and it's available to leave messages. I'm not sure why she's not calling me back but I feel like I have given her a good amount of time to respond. I also sent out a claim tracer and haven't heard anything on that either. I figure the next step is getting in took with the insurance commission.

Any help would greatly be appreciated!

 

[sheardmd]

I have encouraged the patient to involve the Dept of Insurance before on claims issues. I feel like the patients get better response on serious claims issues than providers do. I have had to do this with several claims and have had positive outcomes with having the patient become involved.

 

[MarcusM]

You will need to have excellent documentation to support your case to the insurance commission with proof of timely filing with the original claim(s) and follow up to any EOB's or requests by the carrier for more information. The insurance commission has their own claim forms for these type cases and they are even more nitpicky than the carrier.

 

[npricercm]

Just a thought, I live in Colorado and the Colorado Medical Society intervened with payment issues or information. You might try your state society to see if other providers have the same complaint. Do you have a clean claims law? There's strength in numbers

Nancy Price, CPC

 

[knperry]

This patient was in a Georgia state prison at the time of services so I don't think I'll be able to locate him. I tried calling again and asked to speak to that person's supervisor/boss the person on the phone said she is the boss. Should I contact the warden first or go straight to the insurance commission?