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Contacted insurance rep who (again) told me there is no record of the claim.
In my experience, that is a lie - and standard operating procedure for CIGNA and other large insurers in order to delay or eventually deny paying claims because the claim was submitted "too late." If you search the internet, you will find many insurers routinely employ this technique.
I had the same issue with United Healthcare on a routine doctor visit while insured under UHC Medicare Advantage. Provider resubmitted several times, UHC said claim never received, provider was coming after me for the money - said my problem was the insurer, they were known for this. I finally filed a claim with the BBB, wrote a stiff letter to provider and UHC - claim was paid in two days.
Now someone was lying - either provider never submitted claim or UHC actually didn't get it. In my experience the liar would be UHC.
You are getting the identical run-around all too common with large for-profit insurance companies. Humana, UHC, CIGNA are known for this.
In my experience, that is a lie - and standard operating procedure for CIGNA and other large insurers in order to delay or eventually deny paying claims because the claim was submitted "too late." If you search the internet, you will find many insurers routinely employ this technique.
I had the same issue with United Healthcare on a routine doctor visit while insured under UHC Medicare Advantage. Provider resubmitted several times, UHC said claim never received, provider was coming after me for the money - said my problem was the insurer, they were known for this. I finally filed a claim with the BBB, wrote a stiff letter to provider and UHC - claim was paid in two days.
Now someone was lying - either provider never submitted claim or UHC actually didn't get it. In my experience the liar would be UHC.
You are getting the identical run-around all too common with large for-profit insurance companies. Humana, UHC, CIGNA are known for this.
Most claims are processed electronically these days, and the software used can prove the claim was submitted.
The doctor's office should ask the person or service that is submitting the claims to provide evidence that the claim was submitted.
In my experience, that is a lie - and standard operating procedure for CIGNA and other large insurers in order to delay or eventually deny paying claims because the claim was submitted "too late." If you search the internet, you will find many insurers routinely employ this technique.
I had the same issue with United Healthcare on a routine doctor visit while insured under UHC Medicare Advantage. Provider resubmitted several times, UHC said claim never received, provider was coming after me for the money - said my problem was the insurer, they were known for this. I finally filed a claim with the BBB, wrote a stiff letter to provider and UHC - claim was paid in two days.
Now someone was lying - either provider never submitted claim or UHC actually didn't get it. In my experience the liar would be UHC.
You are getting the identical run-around all too common with large for-profit insurance companies. Humana, UHC, CIGNA are known for this.
I could be naive but this doesn't fit the pattern of service we have received with claims that were much, much higher.
The plan I am on is self insured through my (former) employer. They hire a company called Allegiance-who is owned by Cigna-to process claims according to the policy that the employer dictates.
There are two PPO networks. One is local and the non local one is Cigna. I am willing to bet that 99% of claims are local and don't go through Cigna. The rep mentioned that the non local ones go through Cigna first before coming to him as the local PPO processor. The local claims do not go through Cigna AFAIK.
I'm not sure how Cigna makes money by claiming they didn't get a claim. The money is coming from the employer , not Cigna.
I've contacted someone at the employer that handles these things so we'll see what happens.
Several weeks ago on three way call between the MRI billing folks, myself, and the insurance person at my employer we discover they had the wrong PO box for Cigna. They refile.
About a week later I see the claim in my account as being processed. Victory!
Last night I check and the claim has been processed so I get the EOB.
They paid $0!
It has this code:
I4528 Provider: Submit this claim to CIGNA or to the appropriate specialty network.
What????? It was submitted to Cigna.
In another twist, the bill they sent me was for $2280 but they billed the insurance $1550!
1/23/19-almost one year later- the insurance paid $452 out of $3830.
The bill is from the radiologist who is not in network and thus was paid at the out of network rates. There is no actual bill from the MRI center and the codes used by the MD are for the MRI itself and not his fee. The MD fee would be covered if the center had billed for the procedure since they are in network then the MD fee would be covered in network as a "no choice".
I called the billing folks. They told me they only bill for the physicians and not the MRI centers.
Wait-there is another crazy twist-the billing folks said Cigna told them to bill "Med Solutions". So they did. The problem is no one knows who Med Solutions is. Not the billing folks, my employer insurance rep, or the claims adjuster I have been working with. Google shows they appear to be an insurance company and the billing folks won't do anything until they hear from Med Solutions since that is what Cigna told them.
So now I am back to calling the MRI center starting all over again. The person I dealt with has been replaced and now I am waiting for a call back after two messages.....
They have 180 days from the claim date to resubmit a corrected claim with the MRI center's ID, otherwise I am going to be stuck.
Over a year since my OP and I am still battling this.
Another bill just arrived. They have written off the balance except for $345 which was the coinsurance/deductible from the incorrectly filed out of network provider.
The deductible and out of pocket max were met for 2018 which means the MRI would have been paid at 100% of the contracted rate leaving me with $0 liability if this was filed with the correct in network provider.
Called the billing contractor again. They seem to want to help but then nothing happens. Someone is supposed to call me back.
It doesn't make sense. If they would bill the correct provider they would almost surely get paid more than they already got and would not have to write off so much. This is not my problem though I am trying to eliminate my liability in this.
The clock is also ticking. They have 180 days from the last claim date to refile an updated claim otherwise insurance won't accept it.
Part of me wants to just pay this and be done with it. Another part says just keep fighting.
Over a year since my OP and I am still battling this.
Part of me wants to just pay this and be done with it. Another part says just keep fighting.
Thoughts?
Did you contact HR at your employer? I had an issue years ago with my insurance, I was told before I had an outpatient surgery that the surgery center was in network, but when they billed, the insurance company said it was an out of network facility. I tried to resolve this issue for many months, letters, emails, calls that I documented with no fix. Finally I mentioned this to HR and they said they will contact the responsible parties and get it resolved. They did!
Did you contact HR at your employer? I had an issue years ago with my insurance, I was told before I had an outpatient surgery that the surgery center was in network, but when they billed, the insurance company said it was an out of network facility. I tried to resolve this issue with this for many months, letters, emails, calls that I documented with no fix for this issue. Finally I mentioned this to HR and they said they will contact the responsible parties and get it resolved. They did!
Yes I did and they have been helping me all along.
The crux is the provider was listed as the MD who is out of network instead of the in network MRI center. The MRI center admits this is wrong but neither I nor the MRI center can get the billing contractor to resubmit a corrected claim.
Yes I did and they have been helping me all along.
The crux is the provider was listed as the MD who is out of network instead of the in network MRI center. The MRI center admits this is wrong but neither I nor the MRI center can get the billing contractor to resubmit a corrected claim.
I hope you can get this resolved soon. In my case, the insurance company wrongly stated (after my surgery) that the center was not in network when it was and I had pre-approval (or whatever it's called) that they were in network. This took months to fix. The insurance industry is so difficult for us regular people to navigate, I hope it gets fixed someday, it won't in my lifetime, but hopefully for the next generations.
And I was also ready to pay the extra amount just to resolve this, luckily one call to my HR dept to get some advice resolved this!
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Frustrating update
