Hi guys. Sorry if this is a bad question or easily solved and I’m just ignorant as to the asnwer.
Long story short. Our eldest child hasn’t been on our insurance for almost seven years (aged out).
She recently had a surgery and submitted the claim to her current insurance (which she has had for about five years). It got DENIED. Her company said they denied it because she is already on someone else’s insurance plan. They gave us the name of the insurance company - but WON’T say who the owner of the plan is. Or give ANY details at all except “Blue Cross.”
We are having the hardest time clearing this up. How do you prove you don’t have insurance? If his insurance company would give us just one sentence more of info, we could clear it up. All they say is “Blue Cross” but won’t say the person’s name who the insurance covers, what company its from, etc.
If they would just say the insurance covering you is “Primary owner of the insurance is Joe Blow who worked at Olive Garden in Boise, Idaho.” Then we could say “wrong people, none of us are named Joe Blow, none of us live in Boise Idaho, none of us worked at Olive Garden.”
I guess I can email Blue Cross and give them all the info and see what they can dig up? Or is there an easier solution?
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Unfortunately, you can’t solve this for her. She has to. HIPAA prevents anyone else from discussing this with you. The only person who can get the needed information is your daughter. She will need to call her current insurance and explain that she has no other coverage.
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“She will have to call her current insurance and tell them she has no other coverage.”
That’s the problem. Her current insurance is telling her that she is covered under another insurance company. But they don’t tell her anything about that policy other than it is from Blue Cross. They won’t even tell her the name of the policy owner.
I am going to tell her to call the local Blue Cross agent in her city and tell them what’s happening. Hopefully they can straighten it out.
Thank you for your comment.
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The insurance company might not have the full information. They might receive a claim with only partial details, like an ID# and carrier name, which can be vague (e.g., “Blue Cross” could refer to several different entities). This incomplete info can cause the claim to be flagged, as the insurance company needs to determine which plan should pay first using complex priority rules (Coordination of Benefits, or COB). This is a standard industry practice and can be quite frustrating.
When I worked in the call center, I dealt with a similar issue. I found that one office mistakenly billed the member’s old insurance, which processed the claim in error because coverage hadn’t been terminated yet. When I contacted the office, they confirmed the old carrier reversed the claim after realizing the coverage had ended. I had to go through months of notes to figure out the issue.
If only one claim has been rejected, that might be a clue. First, check what was submitted with that claim to see if it triggered the issue. If your eldest made the submission, do you have a copy of it, or can you contact the billing office to see if they included any confusing information?
If other claims have been rejected, start with the earliest one and investigate it instead.
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Has she ever been on insurance besides yours? This happened to me years ago. Insurance was looking at the insurance information for a plan that was dropped about 5 years earlier
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The issue might be as simple as a provider mistakenly listing “Blue Cross” as other insurance. Your daughter just needs to call and say she has no other insurance, and the claim payment will proceed. I’ve been working in health insurance for almost 30 years.
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Your health care ‘system’ sounds like an absolute nightmare.
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You called the insurance company about your adult daughter and are surprised they wont give you information regarding her stuff? Your daughter should call Blue Cross and ask them.
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No, I didn’t explain my situation clearly. I appreciate your help.
My adult daughter called to say her latest claim was denied because her insurance company thinks she has coverage under someone else’s policy. Her insurance won’t tell her whose policy it is; they just say she must prove she doesn’t have other insurance.
As her parent, I assume the only other policy she could be on would be ours, but she dropped off that coverage when she turned 25. I checked with my insurance company, and it shows she hasn’t been covered since then.
If her company would tell her who owns the policy she’s supposedly covered under, we could resolve this quickly. But they only provide the vague information that she’s covered under a Blue Cross policy, without details on the owner or state.
She just shared this with me. Before I dive into solving this, I hoped someone here in the Health Insurance sub might have experienced this and could offer some tips.