Insurance Claim Denial Dispute

Summary

If your insurance claims are being denied due to the application of incorrect policies, its crucial to address the issue directly with the insurer. In this case, Dr. Munroes claims are being denied under the Medicare Payment Policy instead of the appropriate Blue Cross Blue Shield policy. Despite submitting over 70 medical notes, payment has not been received, and communication has been blocked. Its advisable to gather all documentation, seek clarification on the policy used, and consider legal consultation to resolve the dispute effectively.

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rephrase "We are been informed that your reviewer, Ms. Patricia Neely, is applying the 'Medicare Payment Policy' to deny our claims, accusing Dr. Munroe of billing BCBS-MA for services not rendered. Dr. Munroe has questioned why the Medicare policy is being used instead of the Blue Cross Blue Shield payment policy. Ms. Neely has not answered this question and has even blocked Dr. Munroe’s email instead. Additionally, Rachel Wacht has made it clear that BCBS-MA will not provide the policy being used to justify these denials."
We've received information that your reviewer, Ms. Patricia Neely, is using the 'Medicare Payment Policy' to deny our claims, alleging Dr. Munroe billed BCBS-MA for services not rendered. Dr. Munroe has asked why the Medicare policy is being applied instead of the Blue Cross Blue Shield payment policy. Ms. Neely has not responded and has blocked Dr. Munroe’s email. Additionally, Rachel Wacht has stated that BCBS-MA will not provide the policy used to justify these denials.
Would you like to know what steps you can take next?
rephrase "My wife has contacted your customer service by phone to address the denial, and we were informed by customer service that Dr. Munroe needs to submit our full medical notes. Dr. Munroe has told us that she has already sent over * medical notes, both in English and Chinese, but none of these have been paid, and the reasons given have been unclear or nonexistent. "
Sure, here's the rephrased text:
"My wife called your customer service to discuss the denial, and we were told that Dr. Munroe needs to submit our complete medical notes. Dr. Munroe informed us she has already sent over * notes, both in English and Chinese, but none have been paid, and the reasons given have been vague or absent."
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