Worst Claim Story- August 2018
From Jackie Koontz, Kaizen Coach and Account Executive
In January of 2015, one of my offices had a patient present for a routine crown and buildup replacement. I went ahead and billed the patient’s insurance through Cigna for the services. On March 2nd of 2015 I received a letter from Cigna asking for the prep and seat date of the crown and well as the prior placement date, which is pretty standard. I faxed in the requested information on March 12th (after contacting the patient about his prior placement date) with all of the requested information, and I specifically stated the crown was SO old the patient does not recall the initial placement date. On April 7th, I received yet another letter from Cigna asking for the same information. On April 8th, I called Cigna to confirm receipt of the information sent on March 12th, and was told the claim was processing. 2 weeks go by and no payment comes. On April 24th I call Cigna again. I am then informed that the claim was “stuck” and the new rep assures me the claim is not processing (4 months after the date of service..) On May 12th I get ANOTHER letter from Cigna, this time stating our claim could not be processed due to us not having the EXACT original placement date. By this point, I’m livid. I had never had this much trouble getting a claim paid through Cigna before. I went ahead and appealed the claim, with an additional note directed at the adjuster. “ Unfortunately, the patient doesn’t remember when the crown was originally placed. I can’t extract information from the patient that he doesn’t have. I’m sure that if I had a time machine, I could do some trial and error and figure it out that way, but that technology is just not available at this time.” That extra couple of sentences may not have been the most professional approach, but I was at the end of my rope. After my appeal, the claim was ultimately paid! Whether it was due to my colorful addition, I will never know. But I always like to think that my extra touch of sass got a chuckle out of that adjuster and got that claim paid.
Dental Billing Tips and News for Pros; Edition #126