WCH Delivers on Its Promise as Usual

We successfully appealed a case against Empire BCBS HealthPlus and got our client paid with interest for the delayed payment. Once again, WCH has shown that it always delivers on its promise to help providers recover their payments. To find out how we resolved the case, read along!

As you may have noticed, certain payers like to delay payment and are often reluctant to admit their mistakes. For such payers, you need a service bureau like WCH, which knows how to get things done. At WCH, one of our main tasks is to make sure that claims are sent to the Payer in the right way and at the right time to eliminate any reasons for denial.

Our experience with Empire BCBS HealthPlus

Recently, we successfully completed a case with Empire BCBS HealthPlus. As per our experience, this insurance is infamous for unnecessarily delaying or denying payment. 

A batch of claims with TMS treatment was submitted in a timely manner to Empire BCBS HealthPlus insurance company, and the total expected payment was about $19 000. 

Case 1

For this one, all billed claims with subsequent sessions of TMS treatment got denied. The insurance carrier did not show that the initial session CPT 90867 was billed, but this claim was on file and already paid. 

All efforts to send claims to the payer’s customer services representative were futile, and both levels of appeal yielded nothing. The claims were sent back for reprocessing and got stuck in the system. For more than 2 months, there was no payment.

The doctor was frustrated for not getting paid for the 76 sessions rendered to patients. But we did not give up. Instead, we addressed our complaint to the New York State Department of Financial Services where we proved that all services were billed correctly and there was no reason for the delay in payment. After the DFS review, all claims were paid with interest!

Case 2

In the 2nd case, the claims were incorrectly denied for the absence of authorization. However, the provider’s office checked the patient’s eligibility with the plan three good times, and it was advised that there is no authorization required for the member. Fortunately, the provider’s office kept the reference numbers of those conversations with Empire BCBS HealthPlus’s customer service representative.

The claims were sent back for review several times, and both levels of appeal yielded no result. The patient’s plan still showed that authorization was required, but we had all documentation that proved otherwise. The payer left the claims pending for 2 months, so we sent a complaint to the DFS of NY as we did in the first case. After the DFS review, the claims were paid with interest!  

Both cases were denied due to the payer’s fault, which happens more often than you expect, and we could have proved that by processing appeals with DFS, smooth cooperation between Doctor’s office and the billing team brought its long-awaited results.

A happy client

We informed the doctor about the DFS review and how we won both cases. The doctor was extremely happy and grateful. Seeing what we can do, the doctor trusts us more as a billing company and is interested in other services provided by WCH.

Always true to our promise

With these results, we have demonstrated again how experienced we are at what we do; we do more than just processing claims. We work closely with insurance companies while being ready to appeal denials and reprocess rejections, no-pays, and delayed payments so as to ensure that our clients are in good financial health.