Dani_k_83
Contributor
Hi there,
We are experiencing a problem with Anthem Self funded plans denying services performed by an AS using the remark that it is non-covered under the patients benefit plan. These services are listed under Anthem's approved AS services listing.
We have been writing letters to the employers as well as the plan, requesting a copy of the patients benefit plan summary. We've had some success getting claims reprocessed and paid- simply by requesting this information. However, we have one local employer that is not cooperating. These balances are usually about $5,000 and we really hate to bill the patient for these services when we truly feel that they are not being processed correctly.
We've considered using the DOL but have been instructed that we have no legal recourse thru them; only the patient does. Has anyone else encountered this and what have you done besides billing the patient? Any help is greatly appreciated.
Thanks,
Danielle
We are experiencing a problem with Anthem Self funded plans denying services performed by an AS using the remark that it is non-covered under the patients benefit plan. These services are listed under Anthem's approved AS services listing.
We have been writing letters to the employers as well as the plan, requesting a copy of the patients benefit plan summary. We've had some success getting claims reprocessed and paid- simply by requesting this information. However, we have one local employer that is not cooperating. These balances are usually about $5,000 and we really hate to bill the patient for these services when we truly feel that they are not being processed correctly.
We've considered using the DOL but have been instructed that we have no legal recourse thru them; only the patient does. Has anyone else encountered this and what have you done besides billing the patient? Any help is greatly appreciated.
Thanks,
Danielle