NOVA Healthcare review: Being reimbursed for an approved claim

July 2021 I called Nova to see if speech therapy was an approved service for my son. It was. I had to pay $200 for a deductible and the rest would be covered. I Throughout August and September of 2021 I paid my service provider (who does not accept insurance) for speech therapy. The service provider supplied me with receipts for all the sessions.

After receiving receipts, I called NOVA to see how to submit the claim. The person I spoke with sent me a Medical Claim Form PDF. I filled out the form, copied receipts and sent it in (snail mail). 3 weeks passed and I hadn't heard anything. I called NOVA. They didn't receive it. I filled out the form/copied receipts and sent it in again. 3 weeks had passed and I still heard nothing. I called again. I called and they said they had not received it. On 11/23/21 I faxed in the form and copied receipts (3rd attempt). On 12/3/21 I called and spoke to Justine who said she saw it in the system but she wasn't sure why it wasn't processed. She would speak to a supervisor and call me back. I never received a call. On 12/17/21 I called again and spoke to another rep who told me the claim was missing an AG modifier. (NOTE: I did research because I had no clue what that was. The original receipts included a CPT code but they needed more). The rep called my service provider who didn't know what the AG modifier was either. The rep told me that he would call me back after speaking with his supervisor since I was not the provider filing the claim and they may need to 'cut some red tape'. I never received a call back. On January 10th I called again to find out what was going on. I was told by Morgan that the check was sent to the supervisor for reprocessing. I was issued a payment and I would receive my check in 2 weeks. I waited. Never received a check or a phone call stating that there was a problem. In the mean time, my service provider has been issued 2 checks for her services (a double payment since I already paid her this summer). She refused the check each time and wrote a letter of refusal stating that she was already paid and the company needs to reimburse me. Also in the mean time, my service provider was contacted by the company and given an AG modifier code. She rewrote the receipts and gave them to me. On 2/2/22 I faxed the form and the new receipts (5th attempt). I haven't received a call stating anything was wrong. So on 2/21/22 I reached out to my Human Resource Officer at work and briefly explained this situation. She contacted NOVA on my behalf. She was told that since my son in double covered for insurances, there was an issue and I needed to supply a custody agreement to prove my son is in my custody. (NOTE: My son's father and I live together and we are engaged. There is no custody agreement). My HR officer also told me that I signed an area on a form that sent the payment to the provider and not to you. That apparently is getting cleared up and someone will reach out to me to get it straightened out. The check was sent to the provider in December, so they have to get those funds back and issue a new check to me. (NOTE: the provider sent that check back months ago).

I'm very frustrated that there are so many hoops to jump through when I called in July to see the best route to take so that it would NOT turn into this.