If you use an in network provider and pay a copay, you should not get medical bills but an insurance statement describing what has been paid to your provider. When an out-of-network provider is used, medical billing will occur. This will come from one of the many people, labs, and assorted other medical care providers used. Sort by date of service. That means keep bills, receipts and insurance statements for a particular medical care received together based on date of service. Once in a while, you'll have paid a bill or will expect to pay a bill only to find out that the provider of medical care is a participant in your plan. When this happens, you've paid the going rate out of pocket for care and your insurance company pays the contractual rate to the provider--the provider gets paid twice.
Step 1: If you receive a recurring bill, encourage your medical care provider to go green and stop sending you statements until they have heard from your insurer. If you receive a recurring bill, and you didn't get a copy of your paperwork, ask the medical care provider to give you a statement so that you can submit the claim to your insurance company by yourself.
Step 2: If they have successfully contacted your insurer by submitting your insurance claim (they will know because a claim number will be assigned), you can ask them to wait to hear from your insurer or ask for a statement and submit the claim yourself.
Step 3: If the provider refuses to contact your insurer, send a letter to the medical care provider and your insurance company (same letter), include date of service, date information was submitted to insurance company, and resulting stress being caused to you.
Step 4: If you want to wait another month to see whether this works, fine, you can also simultaneously send the same letter to your State Insurance Department and let them know your insurer is not processing claims.
Step 5: If your bill is sent to collection, call the collection agency and tell them briefly what is going on, then send them a copy of the same letter you've sent to the provider and the insurer with a cover letter documenting that you are being harassed. Further, send a copy of the cover letter to the State Insurance Department.
Reality Check: Insurance companies commit to the vague idea of "processing claims" within a certain number of days. There are several layers of the process, in one of our occurrences, the claims forms were sent back, opened and mangled by the post office or the mailroom at the insurance company. While it's hard to target where that occurred, because it happened several times, we figured it was the insurer mail room and we faxed the information. Then they said that the fax was misdirected to the wrong individual. Next time we faxed and called back right after faxing having gotten a direct line from clerk. Eventually, the form was "processed". Now I call the insurer and ask for a fax number if the claim seems held up at all.
Providers try to strong-arm. Many have the "payment due at time of services" if it's an outside provider. Nothing you can do about this one, bring a charge card or check. Do NOT pay in cash unless you are good at keeping your receipts. If the provider agrees to submit your insurance, still request a copy of your statement of diagnosis and cost of services. You can hold onto the statement in case you do not receive an insurance statement describing that the claim was processed or you can simultaneously submit the claim to your insurer. If a claim is submitted twice then the insurance company notifies you.
In the second case scenario, a medical care provider will defer payment until your insurance claim is processed. Then you'll be billed the amount uncovered. Sometimes the office staff estimates the amount you'll have to pay and charges you that amount up front. In the event this occurs, your communication with your insurance company is the same, get a copy of your statement of diagnosis and services received so that you can also submit your own claim.
Note: Assignment of benefits should NEVER be checked if you have to pay in full for services at time of services. In this case it might give you peace of mind to submit your own claim form.
