Over the last few months, while helping several individuals with claims issues, it was discovered that their Primary Care Physician (PCP) information was out of date. The carrier had one doctor listed, probably chosen at time of enrollment, but the member had switched providers and neglected to notify the carrier.
Hence, claims were denied because of referrals coming in from doctors who were not listed as the patient’s PCP.
It is good to remember that whenever you change PCP’s, either for yourself, or a family member, the change must be made with the carrier as well. This can be done with a quick phone call to the carrier, or in some cases, logging into your health insurance portal and making the change there. New ID cards will automatically be sent out once this call or portal change is made.
By being proactive in this process, you will avoid unnecessary claims denials and the subsequent steps to correct them.
Please contact me directly with any questions and I am happy to help.