Monday, June 27, 2011

Question about a health insurance claim?

I got new health insurance about a year and a half ago when I started a new job. I was sent a dental card and a medical card in the mail not a vision card. Turns out that was by mistake, I was supposed to get a vision card too (doesn't make sense, why not just give me one card!). Anyway, I have a medical condition with my eyes and I guess growing up my parents would put some of my eye exams under medical not vision coverage. I went in to get a check up at my eye doctor. I hand them my insurance card and they ask for my vision card...immediately I'm confused because I know I have the vision insurance but didn't know I had to give them a separate card. So I proceed to explain that growing up sometimes due to medical issues it was billed under medical. They say ok, just send us your vision coverage info later and we will get you squared away. I paid a small fee that day and called the next day to give them all my vision info. Now a month later the doctor sends me a bill? I called and asked and they said the medical coverage denied my claim. I didn't even know how they filed it since I gave them both a medical and a vision card. I called my vision insurer and they said it was the medical people that denied it not them. The vision insurer said tell them to send the claim and we will pay for it all. I call the doctors office to explain and they say they can't send the claim through as a vision claim because they already sent it through as medical. The doctors office said they cannot and will not, they aren't allowed they tell me I call the insurer to tell them this. The insurer says that's bogus. They call the doctor and request them to file a claim. The doctor tells them they can't file the claim as vision because it was a medical procedure? I just had a routine eye exam and a refraction. That's what I got and that's what the doctor told me to tell my insurer. Now when the insurer calls and asks they say otherwise. The bill the Dr sent me has no codes or info explaining what the charges are for, it just lists insurance companies and dollar amounts. I'm going to request a more detailed bill. The secretaries haven't been helpful or nice. I don't see what's going on. I mean I have the insurance why can't they just file it? Why would they just start doing procedures on me without my consent? If they preformed something other than a general eye exam I should have to agree to it first. Any advice?
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you need to do 2 things...file the claim yourself & get a new doc;; when you file your own claim, you'll have to end up paying the doc, then have your eye insurer reimburse you;; this IS a little funny on your doc's part;; but if I were you, I would contact your medical & see what resolved from the claim before you do anything else;; if he already claimed the medical & they paid..well, that's the ONLY reason I can understand why he may not make a second claim to the right party, your eye...good luck, but I would seriously change docs...
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