As things are...long story...
I had insurance through my wife's job. Let's call that insurance X. Last fall I become more of a full time employee within a large system that required I take on insurance with them. To my surprise I was enrolled into another insurance policy. Let's call them insurance Y.
I was in the midst of getting sleep studies done that led to a surgery (tonsils and sinus) within about of month of realizing I had been enrolled in insurance Y. All the claims were sent to Insurance X and paid by Insurance X (the insurance I had been using for years).
I did not realize the difference and/or need to use my new Insurance Y as my primary until recently. I did not know the difference as I've never dealt with this in my life. It was not explained by my employer or the office that deals with the enrollment of members. I recall talking to them and saying "but I have insurance with my wife...I don't need this". She said it was required and it was no cost to me.
I am still enrolled with both insurance X and Y and started to figure out what had happened recently. We called Insurance X and let them know what had happened. They informed us to call all the providers and have them resubmit to insurance Y. I assume Insurance X will be collecting back $ from the claims they had paid as they should have been secondary. We called Insurance Y and told them what happened (and this is where it gets interesting).
In my first call to them, the customer service agent went back and forth with several managers and first told me "leave it be". As in don't tell Insurance X this had happened. I was shocked and said this would be deliberate insurance fraud. I then told her we had already told Insurance X what had happened. She became flustered, talked to another manager and then came back saying I should resubmit but there was 120 day limit on claims and all my claims would be denied as they were too old. We got off the phone.
Still in shock, the manager who apparently gave the "leave it be" directive called me called within minutes of getting off the phone. She said she was going to try and move around my "care team" so all my claims could potentially be covered. She said the limit was actually 15 months not 120 days? My providers for my surgeries etc. are within their network but not my smaller "care team". I would have needed a referral for the doctors etc. that performed my surgery.
She called back a few hours later saying she couldn't move my care team but I should call every provider I've had over the past year and have them resubmit the claims and "maybe...don't know" the claims would be paid or some of them or part?...a big "I don't know"....
I called all the providers and had them resubmit.
Soooo......my big questions...
1. Was it inappropriate for them to tell me to "leave it be".
2. What is the likelihood of Insurance Y paying any of this? And what is the likelihood of Insurance X paying any of this (if insurance Y denies part of some of the claims). I still have both policies.
I had insurance through my wife's job. Let's call that insurance X. Last fall I become more of a full time employee within a large system that required I take on insurance with them. To my surprise I was enrolled into another insurance policy. Let's call them insurance Y.
I was in the midst of getting sleep studies done that led to a surgery (tonsils and sinus) within about of month of realizing I had been enrolled in insurance Y. All the claims were sent to Insurance X and paid by Insurance X (the insurance I had been using for years).
I did not realize the difference and/or need to use my new Insurance Y as my primary until recently. I did not know the difference as I've never dealt with this in my life. It was not explained by my employer or the office that deals with the enrollment of members. I recall talking to them and saying "but I have insurance with my wife...I don't need this". She said it was required and it was no cost to me.
I am still enrolled with both insurance X and Y and started to figure out what had happened recently. We called Insurance X and let them know what had happened. They informed us to call all the providers and have them resubmit to insurance Y. I assume Insurance X will be collecting back $ from the claims they had paid as they should have been secondary. We called Insurance Y and told them what happened (and this is where it gets interesting).
In my first call to them, the customer service agent went back and forth with several managers and first told me "leave it be". As in don't tell Insurance X this had happened. I was shocked and said this would be deliberate insurance fraud. I then told her we had already told Insurance X what had happened. She became flustered, talked to another manager and then came back saying I should resubmit but there was 120 day limit on claims and all my claims would be denied as they were too old. We got off the phone.
Still in shock, the manager who apparently gave the "leave it be" directive called me called within minutes of getting off the phone. She said she was going to try and move around my "care team" so all my claims could potentially be covered. She said the limit was actually 15 months not 120 days? My providers for my surgeries etc. are within their network but not my smaller "care team". I would have needed a referral for the doctors etc. that performed my surgery.
She called back a few hours later saying she couldn't move my care team but I should call every provider I've had over the past year and have them resubmit the claims and "maybe...don't know" the claims would be paid or some of them or part?...a big "I don't know"....
I called all the providers and had them resubmit.
Soooo......my big questions...
1. Was it inappropriate for them to tell me to "leave it be".
2. What is the likelihood of Insurance Y paying any of this? And what is the likelihood of Insurance X paying any of this (if insurance Y denies part of some of the claims). I still have both policies.
