I submit out-of-pocket and out-of-network claims to my insurance company and normally get a check within a few months.
This year has been more problematic. I have a set of ~15 dates of service that I have been re-submitting since the spring.
A few of the claims were processed, but then they mailed the check to the provider instead of me. Insurance co confirmed this was an error.
A few of the claims were denied for not having the right codes, however the codes were right there on the bill and they confirmed that these were rejected in error.
Some dates of service have just been ignored entirely (I submit the claim, but it never shows up in my claims list nor receives communication from the company; per discussions with them it’s stuck in the “uploaded documents” phase and never got moved into creating an actual claim)
I called in about these issues multiple times. Each time the company confirms that they see all 3 errors, understand the mistake and will re-process within 10-15 business days. But that date passes and nothing happens (after repeating this process three times so far). The claims never start being processed or even show up in my claims list.
I escalated to a manager on one call and got her to promise to take responsibility and call me back by a particular date. She disappeared, never called back. I called in again and asked them to have her call me – no luck.
At this point I have no way of getting the company to actually process the claims; they are clearly being lost and never actually processed.
How can I get the company to pay these out? Is it possible to take something like this to small claims court?