As reported in the Los Angeles Times story, Anthem BCBS was caught red-handed in basically a bold-faced lie that would surprise…well, none of us chiropractors. So, while the actual facts of the insurance verification snafu aren’t surprising to anyone in the trenches who has had their fair share of verification “errors” there are definitely a couple of killer tips to learn from the whole mess. Insert Botched Insurance Verification Here In a nutshell, here’s what happened. The patient and spouse called Anthem BCBS to verify that a surgical procedure would be (a) covered and also that (b) the doctor performing the procedure was in-network. Obviously, the patient didn’t want to be stuck footing the entire bill for a non-covered service and also wanted to maximize their insurance by choosing an in-network provider. {Certainly, nothing extraordinary so far…} The Anthem rep verified that the procedure was in fact a covered service and also verified that the doctor was in their network. The diligent patient double checked this information, even spelling the doctor’s last name again for the rep, who was adamant that the verification was accurate. {Obviously, you’ve been down this road enough to smell what’s coming…} Weeks after the procedure {gasp}, the EOB comes back with a denial and the patient is stuck with a big bill {insert fainting here}. Why? Anthem denies that the procedure was performed by an in-network doctor and states to the patient that they must have misunderstood their rep. Had that been the whole story, it would be irritating enough for all of us to relate to. But there’s more… Enter the Super-Savvy Patient Perhaps the patient is a tad paranoid or perhaps the patient is super savvy. Either way, said patient RECORDS the call to the Anthem insurance rep {Legend!}. {You guessed it} The recording features a clear as day verification from the Anthem rep essentially swearing up and down that the procedure would be covered and that the doctor was in-network. Patient then writes an appeal letter, attaches a copy of the recording on CD and hires an attorney to go after Anthem. The PR man from Anthem is now attempting to put a positive spin on Anthem’s dirty laundry and is stating that they are open to paying if the error was theirs. Lawyers are having a field day as they anticipate an out of court settlement as Anthem will likely want to avoid a public trial featuring their bold-faced lies. The rest will be beautiful history. What can we learn? 1. You must take precautions when verifying your insurance coverage. All too often there is an “illusion of coverage” where your premiums are taken and nothing is covered. 2. Record all important conversations with your insurance company. It is very easy to record important phone calls for free. Google voice is an excellent program that will allow you to record calls ported to your own cell/work phone for permanent storage. Our office has begun implementing this for your protection when fighting for YOUR benefits! Sincerely, The Cape Chiropractic and Acupuncture Staff: ~Thanks to the Strategic DC for the story and write-up!
Posted on: Fri, 23 May 2014 03:18:52 +0000
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