Jaycee Brown

Jaycee Brown

Director of Communications

Worst Claim Story December 2019

A Claim was sent to Cigna on Jun 26, 2019. 

-Jul 26 Insurance showed the claim was set to pay up to $558, but pending info from Subscriber.  Mess to office (only they contact patient in this office). 

-July 29, Reply that the office manager left a message with the subscriber and would keep me posted.  

-Aug 2, Rep M – Info about COB clarified. Found the EOB and is sending to process. (It should have automatically been processed as soon as COB was clarified.)  Ref # 23XX. 

-Aug 6 Online was still showing pend for COB so I spoke to Rep R who saw Rep M’s notes. The claim is processing. Ref# 27XX.  

-August 16, Online still shows suspended for info – pending to pay $558 clm ref # S191786XXXXX. Patient’s other claim processed shortly after COB was resolved.  

-Aug 20 Rep J stated claim was just pending – had not been put thru as promised.  J escalating to pay Ref #23XX up to 5 b d.  

-Aug 28, 8/20 sent with NEA # and COB info to process, but processors want up to 30 days extension to process. I said NO WAY. I was promised 5 b d, and itemized the multiple conversations and promises I have been given. I requested a super if she could not get it processed and send in 5 days. Rep resent it with urgent status and notes explaining that: other claim pd, they had info, I had multiple promises of 5 days to pay. She promised 5 days.  

-Sep 5, Rep L – Processed 8/12 pending to pay $558 In review. I told her I do not care that it is in review. It should not have to wait “It’s turn” to go thru review. This was a Cigna error. They should have applied the COB to this claim immediately when it was received, but it was not. It was only applied to the other claim (which got processed).  Since it is Cigna Error it should be put at the front of the line, reviewed and processed TODAY. I know someone there has authority to do so and I want to talk to that person. Supervisor A – Went thru all prev calls with me and all Ref#’s. Discussed all above info. I stated my desire to have the claim hand carried thru review to process today. She could not promise that, but she is sending email directly to review to get my claim reviewed immediately, with the goal to have this paid in 5 d. I told her if it was not, I would go to the insurance commission, and I want interest on this claim.  Escalated call Ref #21XX. 

-Sep 13, spoke to Rep Charlyn and gave her ref #21XX – Paying 9/20 132.30 no ck # yet. 

-Sep 16, check issued $132.30 ck 4704XXXX.

-Nov 15 Sent complaint to the insurance commission due to mishandling of the claim and requesting interest that we were never paid.

Dental Billing Tips and News for Pros; Edition #142

3 Comments

  • I am deducting that Cigna had a non-duplication of benefits clause in the contract as a secondary policy of coverage. This is becoming more commonplace in secondary policies.

  • Ask your eAssist rock star, Erin Buhrer, about the workers compensation claim that took 15 months to get paid! Aaaaagh.

  • I want my claims hand carried from now on too! Way to go!!

Post a comment

Get started with eAssist today

Dental Billing