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Aetna Health Insurance / Denial of claims due to incorrect Tax ID

1 Schenectady, NY, United States Review updated:

I have been dealing with an insurance claim since March of 2008 with countless denials by Aetna. Aetna claims that the wrong tax id number has been filed with the claim, in turn a new claim has been filed with the correct tax id number only to be denied. Each time I call they tell me to have the doctor’s office just resubmit the claim with the correct number and it will be taken care of. The claim has been submitted well over 15 times and they still deny the number is correct. I have spoken to at least 6 different reps some reps numerous times and there still has been no resolution. I am at my wits end with them at this point, it has been almost three years and still no resolution. The Dr office has threatened to send the claim to a collections agent. For some reason now that Aetna won't pay their contracted bills the Dr office feels it is alright to take me to collections and not return any of my calls. Thanks Aetna and Dr Fraterrigo for ruining my credit.

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Comments

  • Ti
      3rd of Dec, 2010
    +1 Votes

    I used to work in medical billing for a large Hospital organization and we used to see this issue all the time. Really the responsibility lies with the Dr Office. You should not have to deal with this issue as it is a mistake easily corrected by the Dr Office billing department calling Aetna and resolving it. Another thing to note is that if multiple claims come in to the insurance company with the same information they will be denied as duplicate filing. The claims system for large insurance companies are automated and they receive the majority of their claims electronically. If your Dr. Office has already submitted the claim with the incorrect TID (Tax ID number) but the claim was not purged from Aetna's system then all incoming claims that match the original claim will be denied as duplicate. Typically incoming claims are identified by the subscribers ID number (your policy number), Date of Birth, Date of Service and Claim amount. The TID is only used to locate the contract information in regards to reimbursement rate and mailing address.

    Most likely the claim will have to be processed manually by Aetna and that will only happen when the Dr. Office's billing department contacts Aetna directly. There is a clause in many contracts between providers (Dr. Offices) and Insurance companies know as "Timely Filing". This clause varies but in general it is a set time period of when bills have to be submitted. If the bill was not submitted and reviewed with in that period the claim will never be paid and the provider will have to absorb the cost. Some smaller companies like Dr. Offices will try to bill the consumer knowing that they have no understanding of the billing process. Believe me in the 6 years I worked in billing it was an always changing and convoluted environment.

    Recently insurance companies have been requiring offices to use their NPI number or National Provider Identifier in place of the TID.

    Good luck to you and hope this information helps...

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