In 2006 and 2007 I visited an out-of-network physical therapist in the hopes of finding relief from chronic pain. Prior to that point in time I worked with in-network specialists, but none of them were able to help me. Each visit to the new PT cost $135. In the beginning I visited the therapist three times a week. As time went on I visited less and less frequently. It’s not that my pain got better but rather that over time the treatments were less and less successful. Paying so much money out of pocket I eventually decided to call it quits altogether.
At the end of each month I would gather my claims together and send them off to the insurance company. For the first month or two I was diligent about filing the claims, but as my visits became more sporadic it became harder and harder to decide when to file them. In January as I was filing an unrelated insurance claim I opened up my medical file and found old PT claims just waiting to be submitted to the insurance company. I pulled out an envelope, typed up a letter, and sent the claims on their way. A few weeks later I received $540.
After receiving the check I logged onto the website of my insurance company to view the explanation of benefits. While I was out there I noticed a few insurance claims from 2007 that had been filed but not paid. After further investigation I found that the insurance company was waiting for detailed information from my physical therapist. It’s clear that I submitted the claims but never checked to see if the insurance company had paid them. (Back then I had so many medical bills it was often difficult to keep track.)
I called up my physical therapist immediately. I felt a little awkward since I hadn’t seen him since the previous summer, but he was as nice as ever and his receptionist quickly pulled the documentation together. I checked the website a few weeks later and found that the claims had still not been updated, so I called the insurance company. I was told that they had not received the documentation. A very kind customer service representative then called the PT, (while I waited on hold), and asked them to fax over the documentation, but a week or two later when I logged onto the website the claims had still not been updated, so I called the insurance company again.
This time they found the documentation, matched it with my account, and sent it off for processing. Today I received notification that I will receive another check for $405. The moral to this story: file your insurance claims. I was unknowingly sitting on $945.