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When I lived in NY, being a born and bred New Yorker, I had no problems with the Insurance Department.

Now in Florida, I had an issue with United Healthcare where they denied the claim for timely filing. This is because the patient kept telling us to bill BCBS. BCBS would deny the claim stating the patient isn't eligible despite repeated calls and where they did verify eligibility. But it turns out that BCBS only handled the inpatient care not outpatient and the patient knew this. By the time he gave us the correct info, which was United, they denied for timely filing. They also denied my appeals by sending me a copy of the benefit manual. They highlighed in yellow the fact that (a) it was the patient's responsibility to send his own claim and (2) he had a 90 day time limit and (3) they would not accept an assignment of benefit form from a non-contracted provider. This is how I started to learn about putting the responsibility into the hands of the patient.

The patient wrote to United complaining that he felt it was our fault and they wrote him a nasty letter telling him HE knew he was responsible for sending his own claim. So, I wrote to the Insurance Commissioner of NY. The patient was a retired State worker, so I also wrote to the Commissioner of the New York State Employees. They both wrote back to me, with a copy of the United's response to them, which said the same thing to me. Both thanked me for my work but I had no authority to send a claim, nor did I have any authority to file an appeal, nor did I have any rights to write to them to complain. They chastized the patient for trying to delegate his responsibility.

United eventually reversed the denial, based on my appeal, and they sent the patient the payment. He wrote that he refused to pay because he didn't like the care he got even though he never complained before. No problemo, he was sent to collections. His condo association found out about it and kicked him out of his condo. He also failed to pay his association dues as well. He tried to get a home loan and was disapproved. He was very angry but I won in the end. He paid but it stayed on his credit for 7 years.

So since then, I changed my policy to not deal with non-contracted carriers. I demand the patient deal with their own denials. We still send claims as a courtesy but if the carrier plays games with us, we tell them we are stopping with the claims submission.