November 2012
Just thought I would share a new payment recovery antic being employed by BC/BS of Alabama. Two years ago we provided a knee orthosis to a very nice fellow who presented a valid BC/BS card. We have a very good policy of verifying insurance coverage before delivery of services and everything checked out correctly for this patient. Services rendered, payment received everybody happy!.
Today ( two years post delivery ) we receive a notice that the subscriber ( our very nice fellow ) was insured by his ex-wife's policy and that the ex- wife had just cancelled that policy retro actively back to 2009 and that BC/BS expects a full refund their payment and if it is not forth coming they will deduct the amount from the next payment or payments due to us. We have consulted AOPA's expert on BC/BS and been informed that they can do this and that we have no options as far as defending our claim for payment from them. Of course we will follow up and attempt collection from the patient and his ex-wife, but just wanted you all to know that a new recovery antic is on the radar.
Thank god it was not a more expensive item !. If anyone has an idea how to defend against this kind of action by a payer please pass it along.
APOA Member
Just thought I would share a new payment recovery antic being employed by BC/BS of Alabama. Two years ago we provided a knee orthosis to a very nice fellow who presented a valid BC/BS card. We have a very good policy of verifying insurance coverage before delivery of services and everything checked out correctly for this patient. Services rendered, payment received everybody happy!.
Today ( two years post delivery ) we receive a notice that the subscriber ( our very nice fellow ) was insured by his ex-wife's policy and that the ex- wife had just cancelled that policy retro actively back to 2009 and that BC/BS expects a full refund their payment and if it is not forth coming they will deduct the amount from the next payment or payments due to us. We have consulted AOPA's expert on BC/BS and been informed that they can do this and that we have no options as far as defending our claim for payment from them. Of course we will follow up and attempt collection from the patient and his ex-wife, but just wanted you all to know that a new recovery antic is on the radar.
Thank god it was not a more expensive item !. If anyone has an idea how to defend against this kind of action by a payer please pass it along.
APOA Member
