What Would Your Broker Do?

Scenario:

A client came to us with about $90,000 in unpaid claims. The insurance company had declined them, mostly because they were out of network. The client had paid about $10,000 out of pocket but decided it was getting out of hand. The vendors were getting anxious. What could the client do?

Possible Responses:

1. This is justification for declaring medical bankruptcy. The actual claims are close to $1,000,000.
2. Try to negotiate with the providers. They would prefer to get something rather than nothing.
3. Keep arguing with the insurance company and escalate the case to the Department of Insurance.
4. Get a good lawyer and sue.
5. None of the above.

Solution:

When we were handling this situation for a client, they really should have enlisted our help early on. Once they called us, we learned that almost all of the services were covered by a retroactive authorization. The insurance company had to be reminded, many times, that they were responsible for the claims. It is surprising how often a wide range of practitioners do not communicate with the insurance companies for payment once a claim is denied.
 
It took a lot of persistence and insistence to speak to supervisors, but we eventually got everything paid by the insurance company. This doesn't always work, but in this instance, our efforts paid off big time for our client.