Persistence Paid Off!
This Cigna claim took 8 months to resolve. The claim was for 3 surgical extraction and a bone replacement graft for DOS 4/19/19. It was originally billed with the wrong rendering provider, but before it paid a corrected claim was sent which showed the correct rendering and billing providers. The original payment to the wrong provider was received via virtual credit card at the end of July 2019.
In August, an online search showed the corrected claim had been denied as a duplicate. Since the office did not accept virtual credit cards, the payment had never been processed. Zelis stated they would issue a stop-payment and process a check within 7-12 business days. The reissued check was made to the original incorrect provider.
On September 9, 2019, I spoke with Cigna and asked for an overpayment refund request to be sent so the payment could be processed under the correct provider per the corrected claim. The office returned the incorrect check and I called every week for 3 weeks and was told the returned check had not been received. On September 25, 2019, the office received a letter from Cigna asking the correct provider to deposit the check and write a refund check back to them. I called and explained that the provider could not endorse a check made to another provider, that would be FRAUD!
Over the next 3 months, I called and spoke to a Cigna representative and/or supervisor 9 different times and received the same information: that Zelis had not sent the money back to Cigna for them to reprocess the corrected claim, even though Zelis had received the returned check from the office. At one point, Provider Relations refused to speak to me any further because I was a third party. The doctor insisted on them speaking to me on behalf of their office.
On November 13, 2019, I sent all of the information over the past 3 months to the Texas Insurance Commission for review. Unfortunately, they were unable to help due to the patient’s specific dental plan.
Finally, on December 10, 2019, a Cigna representative confirmed the refund had been received from Zelis and he pushed the corrected claim through for immediate processing within 5 business days. On December 23, 2019, a check was mailed from Cigna for payment and it was received on January 2, 2020. Persistence paid off!
– Lucinda Lignell