Initial Adverse Determination Denial for something from 2 years ago?


I currently have Fidelis Care Medicaid health insurance and have for about 3 years now.

Given that it's free I don't think I can complain too much. But they do seem to be idiots who have sent me several copies of cards and sometimes deny things. Sometimes I receive letters in the mail from them stating that they've denied something from many months ago. Previously they denied several physical therapy session late last year. I received mail about at the time, tried appealing it, didn't have much luck. Then about a month or two ago I got another letter in the mail saying they've denied a claim for physical therapy from back in December. It confused me, but since the denied a lot of it previously I just ignored it.

However, today I just got 3 separate notices in the mail, all Initial Adverse Determination Denial. They say they aren't bills, and each says that Fidelis has denied payment for a claim, that I or my provider asked for a service(psychotherapy) for 3 different dates in June/July of 2021. The reason given is: "Claim submitted after filing limit, member not liable." Each also contains a form for an appeal.

I am still seeing this therapist and I have absolutely no idea what any of this means. If it means they've suddenly decided to retroactively stop covering therapy for the last 2 years, or if it's just someone at Fidelis randomly pressing buttons and sending me meaningless notices about stuff from ages ago. If anyone speaks insurance, please help.

submitted by /u/Nell_Mosh

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