![]() ![]() The claim denial should be appealed if the massage was administered by a physical therapist. While the massage is a covered benefit, it is likely only covered when the service is administered by a licensed physical therapist, but not when administered by a massage therapist. For example, let’s say you have shoulder pain and go to a massage therapist because you know physical therapy is covered. For instance, a service may be covered under some circumstances, but not others. Out of policyīy signing into your Member Online Services account, you can learn what’s covered and what’s not, and better avoid claim denials. For some procedures, health insurers require information to establish “medical necessity” - records demonstrating that the test or procedure is appropriate and meets the standards of care established by the independent medical organizations that insurers rely on for their medical policy. It may be because your doctor’s office inadvertently excluded a page or other piece of documentation when submitting the request. You can appeal an incomplete claimĪ request for a pre-authorization for a medical procedure may get declined, but not because your benefits don’t cover it. Those denials are, generally speaking, not appealable. Below are two examples that differentiate between a claim denial due to a mistake - which can be appealed - versus one denied because your health insurance plan does not include coverage for that particular service. There are rare instances when a claim is declined due to an error, mistake or omission that could be on the part of the insurer, the doctor or the policyholder. ![]() The appeals process is there to make sure that coverage decisions are based on the facts – facts about your specific insurance policy, your claim and the current medical evidence and standards. Still, if it happens to you, it’s a big deal. But it does happen - in 2018, of the 60 million claims filed with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), just 8,438 were appealed. But, what if your policy doesn’t cover something you expected it to and you need to file an appeal?įortunately, that’s a rare event. That’s a big reason why we buy health insurance. In life, we learn quickly to expect the unexpected. We are adding new functionalities to our app monthly and totally understand your frustration of not seeing Payment center.By Thomas Vincz, Public Relations Manager We are in the process of releasing the Bill Pay functionality through the HorizonBlue app. I feel as if this could be a great app and I would use it more then the online mobile app if the app wasn’t flawed as much. Also, how do I enter in a question I have for the FAQ board if there is no place for me to search/ask a question about anything? I just see the top asked questions (which was not a lot), and nothing I’m looking for. ![]() If there is a way to pay my bill through the app, please someone let me know, cause I googled it and it kept coming back with results for the online site. Why make an app but not include the payment center. It’s as if you have everything I need so far, except the payment center. I notice there was an app so I downloaded it thinking I could go to payment center to make a payment. I just installed the app today because the online mobile site wasn’t loading and showing an error message. We do agree with your suggestion and are looking into adding some of the functionality available through the member portal to the mobile app. Thanks for taking the time to detail your feedback. Please look into this issue because this really is a great app. On the laptop, I was able to fill out much more information, upload my documents, and confirm my billing. When compared to the computer version, the laptop version of the website is much simpler and easier to use. I tried deleting and reinstalling the app, updating it, and restarting it but still I could not get to the proper page I needed to be. After inputting your name, allergies, and any medication you may be on, the app takes you directly to the waiting room to see the doctor. After the first initial step where you fill out your medical history, it does not lead you any further to billing, etc. Yesterday, I desperately needed to talk to a doctor but could not proceed with anyone because the app did not let me do all the steps when filling out my information so I could not upload necessary documentation. I would give the app 5 stars but I believe there is a glitch on the iPhone app that doesn’t allow you to upload your pictures/documents before conferencing with a doctor. I think the nurse chats and telehealth video conferences with the docs are awesome features (especially now with COVID). The app is super convenient and great to use. ![]()
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