private practice, out of network insurance issues

[swisschard]

Ahoy,
I've been doing private practice for a bit, providing superbills to patients so they can submit them to their insurance companies for reimbursement. Now, a couple months later I am receiving a letter from Blue shield of CA in regards to a claim submitted by one of my patients saying I need to "update my credentials." When I call them up, they say it's a new policy that I have to fill out a provider enrollment form for patient claims to be processed, along with copies of DEA, med license, and more--even though I'm not involved with the billing process and do not want to contract with them. Anyone else gotten these kind of letters? Are providers required to register for patients to get reimbursed? It seems like BS to me; I went private practice/private pay to avoid dealing with insurance companies as much as possible.

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[F0nzie]

Yes they always come up with reasons not to pay. This won't be changing any time soon.


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[swisschard]

But can they legally withhold reimbursement to the patient in this case?

 

[FlowRate]

I have to fill out a provider enrollment form for patient claims to be processed

Sounds like a way of tricking you into being paneled. (but unfortunately I know nothing of use otherwise -- I wonder if a post on reddit's legal advice forum might help?)

 

[F0nzie]

But can they legally withhold reimbursement to the patient in this case?

They are legally bound to respond. How they respond is the game they play.


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[trophyhusband]

Yeah, it sounds like they're trying to sneak you in-network. I would just tell your patient to call them and complain that they aren't paying the out of network benefits they're entitled to... and if they don't give the patient can call the California Dept of Insurance to file a complaint. You shouldn't have to fill anything out.

This is of course assuming the patient has out of network benefits. It could be that they do not and they submitted the claim anyway and the insurer is trying to get you in network so they can pay.

 

[PikminOC]

Ahoy,
I've been doing private practice for a bit, providing superbills to patients so they can submit them to their insurance companies for reimbursement. Now, a couple months later I am receiving a letter from Blue shield of CA in regards to a claim submitted by one of my patients saying I need to "update my credentials." When I call them up, they say it's a new policy that I have to fill out a provider enrollment form for patient claims to be processed, along with copies of DEA, med license, and more--even though I'm not involved with the billing process and do not want to contract with them. Anyone else gotten these kind of letters? Are providers required to register for patients to get reimbursed? It seems like BS to me; I went private practice/private pay to avoid dealing with insurance companies as much as possible.

Are they trying to verify you are a physician?

 

[Shikima]

Are they trying to verify you are a physician?

Submit a copy of your license. And tell them to reimburse the patient.