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Worst Claim Story January 2020

When I started with a new office last year they had about 6 claims with Premera that were not being paid due to credentialing. The OM had not completed the credentialing correctly and it was extremely delayed so, as a courtesy, I assisted her. Almost four thousand dollars that they were owed was just on hold due to credentialing. (They were not ready to add on credentialing services for those wondering I just wanted to show the office the magic we do and plant the seed for the next time they think of trying to do it by themselves) Anyways, after helping her correct it, it was accepted but the treating doctor had left the practice and now had his license in Hawaii. Denied again because the services were rendered in WA. I appealed and called and appealed and called. I spent three hours talking to a rep who finally saw the situation and processed the claims. It took a year. It took me sending donuts to the rep that helped me. The last couple of claims are still pending because they needed proof of timely filing but it’s getting done. Collectively I’ve spent more hours than I can count but for Premera to see this as an individual situation instead of just a number took a lot of time, patience and persistence. That’s what we do for these offices. 

*correction to my experience, it took 7 months … but as we all know that feels like a year, or two.

 

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