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any suggestions

I have been having a problem on a Blue Cross account. Blue Cross has requested medical records, which I had sent to them. I have been trying to get these claims paid for months. First, they stated...

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Re: any suggestions

Are you contracted, or not?

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Re: any suggestions

I've gotten on the phone with them and asked for a supervisor, and asked them specifically what they wanted to know, that was not contained in the record. Sometimes this can be resolved that quickly....

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Re: any suggestions

Yes we are contracted with Blue Cross. And as for the supervisor I have talked to three of them. I was told that they are trying to determine whether or not this is a pre existing medical condition...

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Re: any suggestions

If it has been 45 days, transfer it to patient responsibility. If not, wait it out.By the way, did the patient have prior group coverage? If they had continuous group coverage, the p/e doesn't matter...

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Re: any suggestions

Sharon, Thanksyeah this was a new policy but the patient has stated that she has never been treated for this type of injury. And yes it's been way past the 45 days I was just hoping to resolve this...

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Re: any suggestions

Well if you bill the patient it will certainly be an incentive for the patient to march their butt down to the other providers office to find out what is holding up the whole process.Sharon

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Re: any suggestions

Also billing the patient will inspire the patient to contact the insurance company which can be instrumental in getting a claim paid/processed.

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