What To Do When Your Claim Is Lost

What to Do When Your Claim Is Lost

by Tom Necela, DC, CPC, CPMA
January 2010

A frustrating event that happens all too often in your practice is the “lost” claim. Call it lost, non-received, missing, deepsixed, whatever you like–the meaning is the same: the insurance company doesn’t have it and therefore, they are not paying. You can scream, threaten, pull your hair out or summon the great Inspector Clouseau from the dead, but no one is going to find that elusive claim.

Do Insurance Reps Actually Throw Claims Away?

When I lecture on billing, coding and reimbursement issues I am usually required to admit that I “worked for the dark side” (the insurance company). One of my favorite questions that repeatedly comes up, usually in private, is: “Do insurance reps actually throw claims in the garbage?”

While I am certain that each insurance company is different, I will probably guess that there are conscientious people working for every imaginable insurance company–yes, even for your most hated nemesis, whomever that may be.

On the other hand, when you have a stack of “problem claims” on your desk that sits three feet high and grows by the hour, there are some less than diligent and unethical employees who would be faced with a major temptation to accidentally knock a few into the trash which, of course, contains multiple half-empty containers of coffee. The ensuing mess makes the claim totally unreadable and so, sad day, they could not even call up the provider and ask them to re-submit their valiant efforts at attempting to get paid. Instead, these clumsy desk jockeys are forced to shrug their shoulders and head to the restroom to make like Pontious Pilate to wash themselves clean of the whole affair and get on with their day.

The Good News, Sort Of

The tiny nugget of hope in this mess is that most “clean claims” are handled via computer and never have to touch these despicable employees’ guilty hands. However, the sad reality is that most of us have experienced the “lost claim” problem that somehow never gets processed into the insurance company’s system–even if you submitted electronically. So, admitting the imperfections of the system - here’s what to do:

Getting Your Claim to the Insurance - Whether They Like It or NOT

  1. Submit all claims electronically. You can debate speed, costs, paper savings and all the other goodies that go along with why you should do this, but the fact of the matter remains that paper is easier to LOSE!
     
  2. If the claim is lost, re-submit on paper. The problem with most electronic re-submissions is that if they ever find your claim, then it gets rejected as duplicate and you’ve wasted time and money submitting #2. Instead, go straight to paper. If you have spoken with someone at the insurance company, ask to submit it directly to their attention and make them assert a little responsibility.
     
  3. Submit the claim with Proof of Service or Delivery Confirmation or Certified Mail. Depending on the amounts of the claim, all of these options will ensure your claim is there and it may be in your interest to spend the extra bucks to do so.

One Additional Tip

When I worked as an Insurance Claims Analyst, I actually started at the company as a run-of-the-mill customer service rep/grunt. As I got promoted through their system for being mildly competent and reasonably helpful, some of the providers whom I had helped resolve an issue for did something strange: they kept following me.

In other words, even though I was no longer in the department or handling such issues, they kept calling me when they had a problem. Why? They knew that I was responsible enough to either handle their dilemma myself or make sure someone else did. Certainly, your office can do the same.

When calling the insurance, if you meet up with a rep who can get your mess cleaned up, by all means, KEEP THEIR NAME & CONTACT NUMBER!! Then, here’s a kicker that will endear them to you FOREVER. When you have a problem, give them a call (every time) and THANK THEM for their help. In fact, go one step further and send them a Thank You card (costs you $1.50 plus postage).

Or even better, if you have some rep that just helped you get $3,287 worth of claims paid, send them a gift basket of fruit, chocolates, whatever! A $25-35 thank you gift is nothing compared to the obstacle they just helped you overcome AND guess what it will do for you? The next time you call, they will greet you with a smile and solve your problem to the best of their ability again.

Believe me folks, it’s a thankless job, and most people at the insurance companies hate their work. You’ve made a lifelong friend because you are likely to be the ONLY doctor’s office that was EVER nice to them!!!

I can still remember the ONE doctor’s office who ever thanked me and sent me food despite years of working in the same company and helping thousands of providers along the way. You can bet I made sure that guy’s claims were ALWAYS solved promptly!

No, it’s not bribery. I like this point of view better: “Do we not defeat our enemies when we make them our friends?” (Abraham Lincoln).