Worst Claim Story December 2020

Jackie Koontz

A patient came in on 2/11 for a preventative visit and had dual insurance coverage. After the primary insurance processed, the claim was sent to the secondary insurance — this is where the fun started. The office started eAssist services started in April, and this claim was first touched in early May. At that time, Cigna (the secondary insurance) stated they needed the primary EOB in order to process. A week later, the claim was still sitting in limbo, so I attached the primary EOB again via the portal. I called and spoke to a representative and was told it would take 7-10 business days to process. On 6/23, I saw that the claim processed — but at $0. I called again and was told that the claim processed incorrectly and still needed to be sent back for reprocessing. Fast forward to 8/6, and the claim had still not been processed. When I called that day I was told the primary EOB was never attached and would need to be reprocessed. I resent the claim with the primary EOB, thinking maybe the initial submission was completely botched and a new submission would go through. Can you guess what happened next? The claim was denied as a duplicate. On 9/9, I sent an appeal. On 9/22, I called to check on the status of my appeal and was told that it can take up to 30 business days to process. I called again on 10/13, when I was then told appeals can actually take up to 60 business days! Finally, on 11/11, the claim was finally paid — 8 months after the initial submission date.