Wellness

[DrakesMomma]

I've done medical billing for 21 years.  My speciality is follow-up.  

Without seeing your EOB or EOMB the best thing to do would be to call your insurance company (whether Medicare or a Medicare Advantage) and see if they will do a three way call with your doctor's billing office with you on the line.  This usually gets someone's attention in the billing office.  

If the billing office has a pattern of behavior of filing claims incorrectly with enough patients it could trigger an audit with the insurance company.  Those are costly for the provider/billing office. 

[patbz]

I wish that on any topic that requires expertise (insurance, medical procedures)that before a poster goes on and on (and seems to have applicable experience or expertise)we are told what makes that person an expert.  Currently there are several topics being discussed (Medicare and insurance)where a lot of incorrect info being disseminated!  I look up the source material and a few posters are experts!(thank you) but some people just cut, paste and expound some bad info.

[granddi]

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@DrakesMomma wrote:

I've done medical billing for 21 years.  My speciality is follow-up.  

Without seeing your EOB or EOMB the best thing to do would be to call your insurance company (whether Medicare or a Medicare Advantage) and see if they will do a three way call with your doctor's billing office with you on the line.  This usually gets someone's attention in the billing office.  

If the billing office has a pattern of behavior of filing claims incorrectly with enough patients it could trigger an audit with the insurance company.  Those are costly for the provider/billing office. 

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Thank you all for the replies. I don't need help with my Pap claim.I was just giving that occurance as an example. I just feel like many denials are due to a clerical or coding error at some point in the process. The trick is to get the office/hospital to research and refile once they receive the amount due as private pay. Again, my apologies that my thoughts did not translate into a meanful discussion. 

[Auntie CC]

I think in your case it's a coding issue. For a pap needs to go to Medicare as a WELLNESS visit included with your yearly physical. Your doc's front desk needs to schedule your visit as such. If you had a physical at the same time it can all be recoded and rebilled. Good Luck

[Xivambala]

Chrystaltree is right on with their response. I've worked in the healthcare industry for 28 years, both in a clinical environment and pre-authorization of various services with a large insurance company. I have many times had to guide people in resolving their insurance denials. Without being repititious, you must start with your insurance company for assistance. A big thing people overlook also is that insurance companies change their guidlines for services. It's up to the customer to stay on top of that.

[Xivambala]

Excellent Response Chrystaltree!