Worst Claim Story- October 2017

By: Monique Long

I was regularly calling on a few claims for different patients with the same insurance (who shall remain unnamed). When the claims were in the over 30 day insurance aging report the reps would tell me that the claims processed and what they would be paying. They didn’t have a payment date or check YET, but made it sound as though it were just around the corner.

When I noticed these claims were all creeping toward the over 60 insurance aging and still were never paid I started to pry more and then the reps started telling me: “we are waiting for the funds to be released”. This was never said to me in any of my initial call so I continued pressing until I was forwarded to a supervisor.

It turns out that this insurance has to get a “release of funds” acknowledgement from the patient’s employer before they can send payment on claims, they only send this request once and then just sit on it and wait! As soon as I found out that was the hold up, I called each patient to explain the issue and asked that they please contact their HR department so that they could resolve the issue with insurance.

Finally the insurance payments starting coming! Ever since then I’ve always made sure to ask questions and pry a little bit more. If the person I am talking to doesn’t know, I escalate the call to a supervisor!

eAssist Helpful News and Billing Tips; Edition #116


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