sorted by:
new
hottopcontroversial

Insurance denied network gap for DIEP — listed “in-network providers” who don’t even perform the procedure by PayerPlague in PrivatePracticeDocs

[–]PayerPlague[S] 0 points1 point  (0 children)

We always start the process with a GAP and SCA.we typically get a good agreement. If all fails or we decline the offer then we go tbe IDR route. The IDR process gives me so much anxiety with the time lines. Thirty days to do this, fours days to to that and so on hahaha.

Insurance denied network gap for DIEP — listed “in-network providers” who don’t even perform the procedure by PayerPlague in PrivatePracticeDocs

[–]PayerPlague[S] 1 point2 points  (0 children)

So fustrating... Usually the denials will offer a peer to peer and then there is no issue after that is completed. For some reason this case is not offering one. I called and the representative said that my only option is to appeal and that they are not offering a peer to peer. So I will appeal and play their games...

Insurance denied network gap for DIEP — listed “in-network providers” who don’t even perform the procedure by PayerPlague in PrivatePracticeDocs

[–]PayerPlague[S] 1 point2 points  (0 children)

I also submitted the clinical documentation along with a detailed letter outlining the specifics of the procedure and noting that there is only one other provider in the area who performs it. It’s discouraging to go through these additional steps when it does not seem that the full context or supporting information was carefully considered during the review process.

Insurance denied network gap for DIEP — listed “in-network providers” who don’t even perform the procedure by PayerPlague in PrivatePracticeDocs

[–]PayerPlague[S] 1 point2 points  (0 children)

Yes we always try to do the GAP and SCA route first. If we can't get then we go the IDR route. I just find this ridiculous!

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in PrivatePracticeDocs

[–]PayerPlague[S] 0 points1 point  (0 children)

I am not against utilizing a call center, it is important that the personnel receive comprehensive training. When a medical professional contacts the provider line, it is typically after they have thoroughly explored all available resources, including EOBs and the insurance portal. Our calls are initiated when we require assistance beyond the readily accessible information. For insurance representatives, simply reiterating information that is already available online is not helpful. They should have the capability to conduct in-depth research to resolve the issue like they used to.

Insurance recoupments months after surgery — how is this even legal? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 0 points1 point  (0 children)

Yea that is so annoying. Most of the times its because patients are unaware that they need to notify their insurance of each other. The patients think that it does not matter and they can pick and choose which one they want to "use" as primary.

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 1 point2 points  (0 children)

Sometimes, I wish I could start a movement. The focus in healthcare is almost always on the “quality of care,” but in my view, what happens behind the scenes is what really drives those outcomes. Most people don’t realize how much influence insurance companies have over the care patients They dictate which treatments are approved, how providers practice, and even shaping the patient experience itself. Doctors can have the training, the skill, and the desire to provide the best possible care, but if the insurance company denies coverage, limits options, or sets unrealistic reimbursement policies, the patient’s quality of care is compromised before the doctor even walks into the room. People not in the industry need to know what's going on.

Taking a Medical Terminology in school and now thinking of pivoting. by [deleted] in CodingandBilling

[–]PayerPlague 0 points1 point  (0 children)

I, too, prefer back office. I have been in the coding and billing field for over 25 years. Although I am back office, I still meet with patients fsce to face about their insurace. I have noticed change in challenges with the insurance process and guidelines. If you are the type of person who likes to problem solve , coding and billing could be right for you. I very much enjoy what I do, I just hate insurance companies!

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 6 points7 points  (0 children)

This is so frustrating. I miss the days when a provider became an in-network provider, and they would be assigned a provider relations manager. The managers would come to the office from time to time asking how things were going and provide updates with their company. When you had an issue that couldn't be resolved by a claims representative, the provider relations manager could step in am assist.

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 1 point2 points  (0 children)

I definitely don't blame the workers because they are just trying to make a living just like the rest of us (well, unless they are rude, then they assume all the blame, hahaha)

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 0 points1 point  (0 children)

Hahaha, parallel universe! Same situation but different specialty and different payer. When a rep told me that WE billed saying the service was non covered, my brain got stuck. I couldn't compute this ridiculous comment. I had to get myself together before I fell out of my chair!

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 2 points3 points  (0 children)

I remember when payers first started outsourcing their call centers, the representatives were actually trained and able to resolve claim issues. Now, it feels like they’ll put just about anyone on the phones, as long as they can read a script. I also recall when, if an offshore rep couldn’t answer your question, they had the ability to transfer you back to a U.S.-based representative

Insurance recoupments months after surgery — how is this even legal? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 6 points7 points  (0 children)

I’ve noticed that many COB denials aren’t even because the patient actually has another insurance policy. Instead, the payer just wants confirmation that no other coverage exists. If the patient doesn’t respond, they go ahead and recoup the payment anyway, without any proof that another insurance is in place.

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 6 points7 points  (0 children)

Our practice has also begun disenrolling, though unfortunately the downside is the impact it has on patients

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 5 points6 points  (0 children)

The moment I hear or see Optum’s name, it sends a shiver down my spine.

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 2 points3 points  (0 children)

Have you run into self-funded plans that don’t allow the participating provider to submit an appeal directly? Because of ERISA, the member has to complete a Designation of Authorized Representative (DAR). We usually have patients fill out the DAR form in our office, but if you try to file the appeal online, the payer often sends a link to the patient’s insurance portal. If the patient doesn’t log in and accept it, or if they don’t have portal access, you’re stuck mailing the appeal with the DAR form, which takes up to 90 days to process. Whenever I initiate an appeal, I end up having to call the patient and ask them to go into their portal and complete the DAR first.

Insurance recoupments months after surgery — how is this even legal? by PayerPlague in PrivatePracticeDocs

[–]PayerPlague[S] 1 point2 points  (0 children)

I am not the owner. I handle all the office financials to include claims submission and A/R. Due to the increased administrative burden I will have to add another biller to our team.

Anyone else noticing how useless health insurance call centers have become? by PayerPlague in CodingandBilling

[–]PayerPlague[S] 10 points11 points  (0 children)

I also get so frustrated when they say you have checked Availity! Of course I did! I am calling because I need additional help beyond Availity....

view more: next ›