Issue with Medical Services Billing

[Tryin2GetItRight]

I've had Kaiser for over 23 years. Fully vested through my husband's job. I've always waived medical coverage because I had this in place. Tried to waive with my previous employer but they enrolled you anyway - didn't think anything of it because I didn't use it or need it. 

 

Received an email from medical services (therapy) stating that my provider declined payment because they weren't my primary on April 6. In short, Kaiser declined because it showed Blue Shield was my primary (because it was in my name, whereas Kaiser is in my husband's name). I wasn't aware of this because the therapy folks didn't send me anything about declined claims. They gave me 7 days to provide information or they were going to bill me $508.00

 

After researching things, I only needed to provide my policy info for Blue Shield (which they accept) so that they can bill them for the 4 sessions. They're within the duration of coverage. They would then bill to my primary (Kaiser). I gathered this information the same day and this is where the problem started.

 

I've emailed them 4 times, submitted the information online, and called six times. Nobody responded to emails......even the person that emailed me. The folks on the phone are no help.  I ask for billing and they place me on hold, then come back and act as if they can't reach anyone. I've never had an issue like this and frankly don't know what to do at this point. This company is extremely unprofessional and I am worried they will charge me $508 dollars. There's not much time left.

 

If I end up paying, can I file a claim to receive my money back? I thought about trying to find the CEO's email and let him know what's going on with his company. I am in California and wanted to see if anyone has dealt with this type of behavior.

[hegemony]

have you visited the provider to inquire about resubmitting the claim to the proper benefit company? What did your EOB say?

[Tryin2GetItRight]

2 hours ago, hegemony said:

have you visited the provider to inquire about resubmitting the claim to the proper benefit company? What did your EOB say?

I am not sure what EOB is, but I have tried reaching out to the counseling folks to give them the information to resubmit. They won't respond to my emails or calls. I've talked to what is my primary (Kaiser) and they stated that they need to submit to Blue Shield and there's nothing they can do.

[hegemony]

11 hours ago, Tryin2GetItRight said:

I am not sure what EOB is, but I have tried reaching out to the counseling folks to give them the information to resubmit. They won't respond to my emails or calls. I've talked to what is my primary (Kaiser) and they stated that they need to submit to Blue Shield and there's nothing they can do.

EOB stands for Explanation of Benefits

 

 

[StarkRaven$]

Do you have access to an online account with kp.org? If so, start a grievance. They will have to respond. With that said, Kaiser is single payer and I don't think they accept other insurance. 

[CreditSucksNot]

20 hours ago, Tryin2GetItRight said:

I have tried reaching out to the counseling folks to give them the information to resubmit. They won't respond to my emails or calls.

You can pay them and submit a claim yourself to Blue Cross Blue Shield.  Then they reimburse you.  If by chance you pay the provider more than you would owe and the EOB comes back saying they billed X (and you paid X) but the EOB only says you owe Y then the provider would have to refund you the difference you paid.  Protecting your credit is way more important than getting bogged down in who is submitting a claim.  While most providers do bill insurance directly as a courtesy to patients they are not required to.  They are your benefits and ultimately the burden is on you to see that they are used correctly and that does not mean waiting for anyone else to handle it until the time to file a claim lapses and it is no longer eligible for coverage.  

[StarkRaven$]

Kaiser is a managed care HMO being both an insurer and provider. I doubt they would accept outside insurance but do go ahead and pay up front. Then, submit for reimbursement.