Worst Claim Story- May 2018

By Natalie Lucken, Account Manager

Here is another claim story for you about a claim that I kept submitting to a smaller insurance company, over and over again, and it was never getting where it needed to go. I verified the mailing addresses, payer ID, fax numbers, person to whom I should address it, etc., and it still could not seem to find its way to the Processing Department.  Once I was even sure I sent it to the right person when the fax went through, and I gave them 3 weeks to pay on the claim. What a fool I was!

On the final round of trying to fax it, I put the pages together again in my virtual fax, and sent it to the fax number they had given me. Just to be generous, I waited a couple of days to call them back….. The answer I was given shocked me,  but I guess I shouldn’t be so surprised! The gal I was speaking to told me the claim had not been received again. Frustrating! I told her I had a confirmation from my fax that the fax did indeed go through and was received on her end. She put me on hold, and went to go down to the mailroom/fax room and check for herself.  She came back several minutes later, and said that she had found the fax in a sort of basket– sitting there unprocessed. The reason she said is that the fax pages had come in in the wrong order! Really?!?! I tried to keep calm, but I rather loudly said, “Are you serious?!” She answered with a very quick “Yep! That’s why it didn’t get processed.” I followed up with, “So you let it sit there for an entire month?!” And again she said, “Yep!” I told her I wanted it processed IMMEDIATELY and told her I would wait on the line while she did so….

I documented this nonsense into the patient’s insurance follow up notes, of course, so I could be sure to let future ‘Claim Chasers’ like myself be forewarned about what kind of insurance this was.

eAssist Helpful News and Billing Tips; Edition #123

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