Medicare claim denied - physical therapy provider does not accept Medicare
me...@cyvest.com
I filed the claim, using form CMS-1490S. The claim was denied,
saying
- information required to make payment was incorrect
- your provider must complete and submit your claim
The service was prescribed by a licensed physician.
The claims processor, Bene Submit Placeholder, Nhic Corp, will not
accept calls from beneficiaries, meaning that I can't find out what
information was incorrect.
More important, however, seems to be that Medicare says that any
provider that provides a claimable service must participate in
Medicare ... they won't pay otherwise.
Do I understand this correctly?
Is there a way that I can receive Medicare reimbursement for this
claim?
Thanks for any help.
Larry Mehl
JR Weiss
Fill out a new claim form as much as you can. Take it and an addressed, stamped
envelope to the provider and ask him to finish it and send it. If he gets $$
from them, he'll refund it to you.
Next time ask your doctor to recommend a therapist that accepts Medicare.
George Grapman
and ask for advice/help. Government agencies tend to jump when they are
contacted by people who vote on their funding.
This works on all levels. Many years ago I got a ticket in LA and I
paid it. When my license was up for renewal I was told that I could not
do it until I paid the ticket. I mailed a copy of the check to DMV but
all they could say was there was hold. I finally called my state
representatives office for help.A few hours later DMV called to admit
they had erred.
sarge137
wrote:
> "mehlREMOVET...@cyvest.com" <m...@cyvest.com> wrote...
> > I filed the claim, using form CMS-1490S. The claim was denied,
> > saying
> > - information required to make payment was incorrect
> > - your provider must complete and submit your claim
>
> > The service was prescribed by a licensed physician.
>
> > The claims processor, Bene Submit Placeholder, Nhic Corp, will not
> > accept calls from beneficiaries, meaning that I can't find out what
> > information was incorrect.
>
> > More important, however, seems to be that Medicare says that any
> > provider that provides a claimable service must participate in
> > Medicare ... they won't pay otherwise.
>
> > Do I understand this correctly?
>
> > Is there a way that I can receive Medicare reimbursement for this
> > claim?
Unless the rules have changed since I helped my parents with their
Medicare claims (5+ years ago) Medicare should honor a claim for
treatment they cover whether or not you use a network provider, up to
what they've determined to be "reasonable and customary" charges for
your area. Any difference will need to be worked out between you and
the therapist if you went outside the network.
> Fill out a new claim form as much as you can. Take it and an addressed, stamped
> envelope to the provider and ask him to finish it and send it. If he gets $$
> from them, he'll refund it to you.
>
> Next time ask your doctor to recommend a therapist that accepts Medicare.
>
Excellent advice. My primary care provider is in my insurance
company's network, and I always allow them to select specialists
within that network. Other than my normal co-pays I've never gotten a
bill. Most claims processors won't take phone calls because if they
did they'd never get anything done. Even when they have a customer
service line, about the only thing you can do is talk to a CSR who
will escalate your problem or question, unless it's very routine, to
an adjuster or claims investigator who will get back to you when they
can.
Next time you need a specialist, if your primary care doctor can't or
won't do a network referral, ask the specialist if they're in your
network, not if they accept your insurance. Almost everyone accepts
almost every insurance. By becoming a network provider they've agreed
to either provide the service for what your insurance is willing to
pay (less your copay), or at least disclose any additional charges
before you commit to the treatment.
Regards,
Sarge