Of course, they would have to be willing to admit it was their error.
It might be best to ask them to check there and give them enough time
to claim that the doc just called it in before you ckeck back with
them ; - ) .

I'm sure of it - seriously. I know for a fact (because some
disgruntled underlings have admitted it) that when they get too many
claims to process they are told to just start rejecting some. At worst
it delays the time until they have to pay and spreads their workload
out into a more managable time frame and at best a lot of the claims
never get resubmitted (for several reasons that are all bad).

In my old office we adapted by doing basically the same. If we got
more rejections than we had time to individually investigate we would
just start resubmitting them as is. We found that about half of them
were accepted the second time around.

My favorite was when they would reject a claim and tell you what was
wrong. Things like, "you have the wrong account number. That first
digit is an O not a 0." Well.......if you know that.....

Blue choice is famous for a really nice one. There is a rule that you
have a time limit (usually 60 days) after the services are rendereed
to originally submit a claim. After that you have like 90 more days to
resubmit rejected claims. When a new patient (say a new child) is
added to a policy they take a good 4 weeks until after the paper work
is completed to add the kid. They then pay retroactively to the birth
but there is a catch. In those 4 weeks (or more) there is usually one
or two visits by the ped in the hospital (or more), a one week check,
and possibly a one month check. All of those visits will be rejected
saying the patient is not in the system. No problem, just resubmitt
and get paid retroactively when the kid is in the sytem, right?

Wrong.

The tricky part is that they don't enter it into the system. They just
return the claim form with a nice little note saying, "sorry, he's not
in our system." This, of course, takes a few weeks to come back which
puts it right about, you guessed it, at the deadline to file the
claim. What they are supposed to do is to put the claim into the
system and offically reject it. That way there is a record (and an
explanation of benefits form is sent to the subscriber - leading to
irate phone calls about why they are not paying). The difference is
that they just kind of do it informally so there is no record in their
computers.

Doing it this way has two consequences. As I said before it keeps the
subscriber in the dark because no EOB is sent. It also means that if
the doc's office is not on the ball he won't get paid for those first
several visits (and sets up a nice little confrontation where the
insurer claims he was not paid because he never filed the claim). The
office either has to refile the claim in the possibly several days he
has before the 60 days expires (it may already have passed) or be sure
to keep those nice little informal notes as proof that the claim was
submitted.

Nice, huh?

Basically, the more confusion there is surrounding the billing the
less they pay out. So I have no doubts that they do some things to
foster confusion.

But what if the confusion leads them to paying too much? It is not
common but it does happen. If the doc discovers a year down the road
that there was an error he is probably past the deadline and out of
luck. If the insurer discovers a year down the line that there was an
error they just send a letter to the doc saying that he was overpaid
and that they will take adjustments out of future payments. Unless it
happens enough for a class actions suit to be filed (which happend to
Aetna- and they lost) there isn't a whole lot the doc can do because
we are usually talking about far less than a lawsuit would cost.

The industry average is for every primary care doc to employ between
one and two full time people (per doc) to do nothing but deal with
insurance.

People are always claiming that they would like to reduce doctor's
fees. One way would be to force the insurers to accept standardized
online claims and referal forms. That way they could be automatied and
that count could drop from two people per doc to less than 0.5. But
the insurance company's lobbyists won't let that pass because they
like to make it hard to submit claims and make referrals.

Not possible.