Question
Hi Tricia,
My Medical insurance company is Lumenos.My son was born in August 2008 and all the bills which were submitted on time were paid by the insurance company. However just a few days back I receivced a mail which stated that approx is still unpaid and the explanation given is
Dn001: the timeframe in which claims must be submitted for consideration has expired.
L0014: The allowed amount reflected above is greater than the provider's billed charges due to a pre-defined negotiated rate for this particular service. Due to the contract guidelines, the provider is required to be reimbursed for this service or block of services at the full negotiated rate.
I am totally confused, will I have to pay this large amount?Please let me know.
Waiting eagerly for your reply.
Thanks and Regards
Santosh
Answer
Hi Santosh!
If a provider does not send in a claim within the timeframe of an insurance company than they have to take the lost not the patient.
As far as the second denial code L0014, they are stating that the providers bill was less than the allowed amount due to a negotiated rate, thus they would be paid at full rate.
Look at the paper that the insurance sent you with these denial codes to see if they state you are responsible for the charges. If not, I would not worry about it. If you can not tell call the insurance company directly and ask them.
If you are responsible then you need to call the Dr/Provider of these charges and see what is going on since looks like to me their bill would have been paid if they would have submitted on a timely basis. However perhaps they did and have proof to show they did which they will just have to resubmit showing.
Good Luck!
Tricia
