Blind Submissions..DO IT YOURSELF!

Anyone ever get a staff member at a Bariatric Clinic who "pushed off and pushed in" incomplete paperwork to an insurance company?! 

We were under the impression that the "insurance specialist" KNEW when to submit a claim. However, we got an "insurance specialist" at a Bariatric Clinic who submitted a claim to our Insurance Company, w/o verifying if all the documentation WAS EVEN WHAT THE INSURACNE COMPANY REQUIRED. But in "her mind", she submitted everything that the company required.    Common sense:  If the claim was denied for incomplete documentation/proof, that means (HELLO) ALL the required needs were not met and sent in. If you DO NOT HAVE that, DO NOT SEND IT IN, no?! Pick up the phone, and inform the patient that is PAYING your salary! She can't understand the requirements so she rushed through it t get it off her plate, to wash her hands of it. Even the Insurance company told us it was a half hearted rushed job. And they see alot of paperwork in a day from all kinds of Bariatric Centers. So it was SO BAD IT WAS NOTABLE!  And yet she is saying she submitted all the correct documentation. Mind boggling.  I don't get it. Would you submit a half complete thesis if you were told that to do so would cause you to fail your course, and then to pass you'd have to appeal with the Deans office?   Is it just ME?!!   Do these "insurance specialists" so many Bariatric Centers like to sale you on, do their best even if they're best is causing their Dr to lose money & patients?  Now that we've been denied, after ASSUMING she had what she needed for submission, we know ALL THE RULES, and are now painfully aware.Do you think they care?  Nope. No they do not. They have 400 other patients. People, if you have the chance to submit the first clam yourself, DO IT. DO NOT trust staff to get it right, or to be genuinely concerned for your case...because if they mess up, it's your life on the line!

Becasue of this womans total incompetance, and/or desire to ru**** off her plate, my DH is now having to delve into the appeals process now. She somehow thought it was perfectly OK to send in HALF BAKED paperwork...?!?!?! YES YOU, DR ENOCHS OFFICE IN NC. Your staff is complaining that they need more staff. And another thing, I've never heard of one person having so many personal issues to excuse her from utter incompetance on the job. Is that MY problem? Why yes, it is now!

I am sorry for the problems you are having and hope you can get your denial overturned asap. As an Insurance Specialist myself, I can assure you that not all of us push off paperwork, just to get it off of our desk. Denials are more work than getting the approval initially.  It's the last thing I ever want to see happen!   Being an Insurance Specialist isactually a very difficult job that requires extensive knowledge about the requirements of many, many insurance companies--and these requirements are constantly changing. I always tell all of our patients that it helps me and them, if they become proactive in their approval.  We work together, and with a patients cooperation, the end result is almost always positive. However, even the most knowledgable Insurance Specialists get denials.  Insurance companies are inconsistent.  They are always "losing" paperwork.  I can't tell you how many times I am told that they didn't recieve something that I have sent in! I can not speak for all insurance specialists, but I can tell you that with any denials that I recieve, I take it very personally.  I probably get as upset as our patients! I really hope that your doctor's office is able to assist you with your appeal and you have a happy ending. Good luck with everything and if there is anything I can do, don't hesitate to contact me. Tracy Burch Office Manager/Insurance Coordinator Dr. Trace Curry's Office 513-559-1222 [email protected]