Question
What is the name of your state? CA
I went to a provider for physical therapy in January, 2004 where I had 4 visits. After that I went to another provider for Physical Therapy. I was on a PPO plan with blue cross and had 24 visits as my quota for Physical Therapy. I used to call up blue cross to find out how many visits were left so that I don't exceed my quota and used up all 24 visits with my new provider(I never checked the breakdown of how many visits with which provider)
Now I suddenly receive a bill from the first provider stating that blue cross has refused to pay the bill and the hefty amount for those 4 visits is my responsibilty .
On digging deeper I find out thatthe first provider had billed blue cross only in November, 2004(to be precise Nov. 11 2004) for services performed in January, 2004 and because of which I never got the correct number of visits used from blue cross. Am I at fault here? With busy schedules is it my responsibilty to keep track of all visists made to which providers etc. Do I have a case here? If so, is is against the provider or blue cross?
Thanks in advance for replying. I would really appreciate if someone could respond.
Answer
Yes, it is your responsibility to keep track of your visits. You are the only one who know the total of how many visits you have made; your carrier knows only what has been billed and any one provider only knows about your visits to him. You, however, were present for all of the visits; why should someone else be responsible for keeping track of what you can do easily?
You do not have any kind of legal case against anyone.
Answer
What is the name of your state? CA
I went to a provider for physical therapy in January, 2004 where I had 4 visits. After that I went to another provider for Physical Therapy. I was on a PPO plan with blue cross and had 24 visits as my quota for Physical Therapy. I used to call up blue cross to find out how many visits were left so that I don't exceed my quota and used up all 24 visits with my new provider(I never checked the breakdown of how many visits with which provider)
Now I suddenly receive a bill from the first provider stating that blue cross has refused to pay the bill and the hefty amount for those 4 visits is my responsibilty .
On digging deeper I find out thatthe first provider had billed blue cross only in November, 2004(to be precise Nov. 11 2004) for services performed in January, 2004 and because of which I never got the correct number of visits used from blue cross. Am I at fault here? With busy schedules is it my responsibilty to keep track of all visists made to which providers etc. Do I have a case here? If so, is is against the provider or blue cross?
Thanks in advance for replying. I would really appreciate if someone could respond.
Omigosh! Folks, when will we all learn that insurance is a responsibility, not a right? Insurance is a contract, read the damn contract! (your plan book) DO NOT depend on physician / provider filing of your claims!!!!!!!!! YOUR responsibility!!!!Your provider will tell you they will check these things and they often do, but ULTIMATE responsibilty is yours!!!! lkc15507