When it comes to health plan claims, no news isn't good news

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Olin Yarberry says in March 2016, after visiting a Dignity Health emergency room in Gilbert, he expected the claim to be paid as normal through his insurer Maricopa Health Plan. (Source: 3TV/CBS 5) Olin Yarberry says in March 2016, after visiting a Dignity Health emergency room in Gilbert, he expected the claim to be paid as normal through his insurer Maricopa Health Plan. (Source: 3TV/CBS 5)
CHANDLER, AZ (3TV/CBS 5) -

If you don't hear from your health insurer within a few weeks regarding a recent health care service, you should take action.

When you receive medical treatment, the health care provider bills your insurance and usually within a month the claim is processed. If you don't hear about your claim within 30 days, failing to act can be costly.

Olin Yarberry says in March 2016, after visiting a Dignity Health emergency room in Gilbert, he expected the claim to be paid as normal through his insurer Maricopa Health Plan. But eight months later, he got a $1,700 bill from a debt collector. He called Dignity in a panic.

"They were going to freeze it and then resubmit the claim, and investigate why the claim didn't go through and that's when it was brought to my attention that it could be a clerical issue," Yarberry said.

Two months later, Yarberry says he got the same bill and same story from Dignity. Two months after that he called Dignity again to make sure the claim had been submitted.

"They said, that it was a zero balance, so that was it, so then I let it be," Yarberry said.

His content didn't last long. Just a month later, Yarberry says he found a derogatory mark for the $1,700 ER visit on his credit report. Yarberry says he had insurance but Maricopa Health Plan never got a claim and Dignity was no longer willing to help.

"She said, once it leaves Dignity, and gets charged off, there's nothing they can do," Yarberry said.

Now he's forced to fight the debt collector on his own. Most claims are processed without a problem, but if consumers don't hear from their insurers, they should reach out themselves.

"They'll tell you if the claim has been submitted, not submitted. They'll tell you your benefit coverage," Yarberry said.

Patients with typical commercial health insurance receive an Explanation of Benefits (EOB). If you don't get one within 30 days of service, call your insurer and inquire.

Yarberry was under Arizona's Medicaid program AHCCCS. Since AHCCCS patients typically don't have any payment responsibilities, EOBs are not mailed. So, even though it's a hassle, AHCCCS members should wait 30 days from the date of service and then call the insurer they've signed up with under AHCCCS to confirm the claim has been processed.

CBS 5 News contacted Dignity Health. They found the clerical error, wiped out the debt, and had the account removed from collections. We thank Dignity Health for quickly resolving this clerical error after we brought it to their attention.

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Copyright 2017 KPHO/KTVK (KPHO Broadcasting Corporation). All rights reserved.


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