Published by Robert on 24 Oct 2011
The insurance game
In August and September I had gone to see a chiropractor and paid out of pocket since this individual was not on the list of preferred providers. When I have an appointment with a preferred provider, I pay $15 per visit. When I have an appointment with a doctor who is not a preferred provider (PPO)there is no deductible. The insurance company, American Specialty Health, then pays them the amount allowed. Yes, the doctor must sign up to be on the preferred provider hit list. Since my chiropractor is not PPO, I was told I would get the exact amount of money I paid out and it would go towards my yearly amount allowed.
I sent it first to Health Net, my insurance carrier, who did not tell me that I needed to send it to American Specialty Insurance who handles chiropractic claims. When I sent it to them, I was given reason upon reason why they would not allow it.
When I talked to customer service they informed me that I needed a receipt. I told them it would be fraud if I and the chiropractor lied which was shown on the insurance claim filed. Customer service then talked to their supervisor who gave it the okay.
I followed up a couple of days later and I once again got the run around. American Specialty Insurance said I need to put the amounts in the “charge box” area to go along with the codes. I sent the correct amounts with the codes only to get a letter stating that the doctors name and address are illegible. As I look at the claim it is clearly printed, not written. So now I will send it to them again, highlight it in yellow so they can clearly see it.
On another note, I was told that claims need to be submitted in a certain time frame or they would not be accepted. The person did not tell me how much time I had left before American Specialty would not accept the claim.
I am still in the process of trying to receive t he money I laid out for two sessions. Nothing like insurance companies trying “screw” the public.